Hayley B. Gershengorn, MD Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York

Daily Chest X-Rays Still Overused in Mechanically Ventilated Patients

MedicalResearch.com Interview with:

Hayley B. Gershengorn, MD Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York

Dr. Gershengorn

Hayley B. Gershengorn, MD
Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Beginning in December, 2011, professional guidelines have recommended against the practice of daily chest radiography (CXRs) for mechanically ventilated patients.  However, we hypothesized that this practice was still commonplace in the US and varied from hospital to hospital.

To address this question, we performed a retrospective cohort study of >500,000 mechanically ventilated adults across 416 US hospitals. We found that 63% of these patients received daily CXRs and that, while use has been decreasing, this decrease is small (a 3% relative reduction in the odds of daily CXR receipt per discharge quarter starting in 2012).

Moreover, the hospital at which a patient received care greatly impacted the likelihood of daily CXR receipt.

MedicalResearch.com: What should readers take away from your report?

 Response: De-adoption of daily CXR use for mechanically ventilated patients has been slow and is affected by practice setting. This low-value practice may represent an important target for quality improvement initiatives which could significantly optimize resource use and reduce cost.  In fact, we estimated that “if the rates of daily CXR use in all hospitals in the highest 3 quartiles of use were decreased to the rate of the hospital with the highest rate of use in the lowest quartile (ie, only 50% of patients receiving MV in these higher-use hospitals received a daily CXR instead of 71%), more than 2 300 000 fewer CXRs would be performed in the United States annually at an estimated cost savings of more than $144 million.”  

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future research related to this work would take, in my opinion, two forms.  First, as has been increasingly recognized within the critical care community, we must focus on implementation (or, in this case, de-implementation) science.  Specifically, we must evaluate and understand why we are not successful in adopting (or, de-adopting) evidence-based practice.  Our work on daily CXRs demonstrates a gap between “what we should do” and “what we actually do”.  Implementation work is needed to understand why this gap exists and how to bridge it.  Second, our findings may compel individual intensive care units, hospitals, or healthcare systems to initiate quality improvement projects aimed at reducing daily CXR use locally. Understanding the impact of these initiatives may provide insights into what may and may not work for de-adoption of many “standard-of-care” practices in unique ICU settings.

Neither I nor any of my co-authors have any disclosures to report.

Citation:

Gershengorn HB, Wunsch H, Scales DC, Rubenfeld GD. Trends in Use of Daily Chest Radiographs Among US Adults Receiving Mechanical Ventilation. JAMA Network Open. 2018;1(4):e181119. doi:10.1001/jamanetworkopen.2018.1119 

Aug 15, 2018 @ 2:00 pm

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