The Science Journal of the American Association for Respiratory Care
Background: An ordering practice review in our hospital focused on ABG and CXR utilization in the SICU. We felt that we could develop protocols and/or guidelines and thus decrease utilization by 30%. Outcome monitoring would assess goals and assure no significant negative impact on quality occurred. Our patients routinely had ABG's ordered q am and after most ventilator changes. CXR's were obtained q am and after invasive line procedures. Method: Literature review and discussion of practice patterns helped determine criteria for ABG and CXR guidelines. The ICU populations targeted included surgery, vascular, and trauma patients. ABG and CXR utilization rates were determined by analyzing the total number of ABG's or CXR's obtained per day and then were compared to daily unit census. Costs were determined by assessing actual hospital costs associated with obtaining and processing ABG's and analyzing the costs associated with performing, processing, and filing the CXR's. Outcome measures were reviewed daily and weekly through both multidisciplinary rounds along with weekly Quality Improvement Committee meetings.
Results: ABG utilization decreased 30% over a five month period. In addition, CXR utilization decreased 70%. There was no significant increase in stat orders for CXR's. No significant negative outcomes were noted. This included unscheduled returns to the ICU, length of stay in the ICU, and unexpected events or complications. Experience: Attending physicians have adapted to the changes and continue to focus on assessment of the patient. They review the residents' findings and plans along with discussing appropriate ordering and utilization of ABG's/CXR's. Conclusion: Appropriate use of ABG's and CXR's can be achieved through guidelines or protocols. We have experienced no adverse events related to institution of unit ordering guidelines. Cost reduction from these two initiatives amounted to over $27,000 for the five month period.