• Silas P Trumbo, Wade T Iams, Heather M Limper, Kathryn Goggins, Jayme Gibson, Lauren Oliver, David L Leverenz, Lauren R Samuels, Donald W Brady, and Sunil Kripalani.
• Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
• J Hosp Med. 2019 Feb 1; 14 (2): 83-89.

BackgroundChoosing Wisely® is a national initiative to deimplement or reduce low-value care. However, there is limited evidence on the effectiveness of strategies to influence ordering patterns.ObjectiveWe aimed to describe the effectiveness of an intervention to reduce daily chest X-ray (CXR) ordering in two intensive care units (ICUs) and evaluate deimplementation strategies.DesignWe aimed to describe the effectiveness of an intervention to reduce daily chest X-ray (CXR) ordering in two intensive care units (ICUs) and evaluate deimplementation strategies.SettingThe study was performed in the medical intensive care unit (MICU) and cardiovascular intensive care unit (CVICU) of an academic medical center in the United States from October 2015 to June 2016.ParticipantsThe initiative included the staff of the MICU and CVICU (physicians, surgeons, nurse practitioners, fellows, residents, medical students, and X-ray technologists).Intervention ComponentsWe utilized provider education, peer champions, and weekly data feedback of CXR ordering rates.MeasurementsWe analyzed the CXR ordering rates and factors facilitating or inhibiting deimplementation.ResultsSegmented linear time-series analysis suggested a small but statistically significant decrease in CXR ordering rates in the CVICU (P < .001) but not in the MICU. Facilitators of deimplementation, which were more prominent in the CVICU, included engagement of peer champions, stable staffing, and regular data feedback. Barriers included the need to establish goal CXR ordering rates, insufficient intervention visibility, and waning investment among medical residents in the MICU due to frequent rotation and competing priorities.ConclusionsIntervention modestly reduced CXRs ordered in one of two ICUs evaluated. Understanding why adoption differed between the two units may inform future interventions to deimplement low-value diagnostic tests.© 2019 Society of Hospital Medicine.

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