• Joseph E Tonna, Kensaku Kawamoto, Angela P Presson, Chong Zhang, Mary C Mone, Robert E Glasgow, Richard G Barton, John R Hoidal, and Yoshimi Anzai.
• Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, United States; Division of Emergency Medicine, Department of Surgery, University of Utah, Salt Lake City, UT, United States. Electronic address: joseph.tonna@hsc.utah.edu.
• J Crit Care. 2018 Apr 1; 44: 182318-23.

PurposeStudies suggest that "on-demand" radiography is equivalent to daily routine with regard to adverse events. In these studies, provider behavior is controlled. Pragmatic implementation has not been studied.Materials And MethodsThis was a quasi-experimental, pre-post intervention study. Medical directors of two intervention ICUs requested pCXRs be ordered on an on-demand basis at one time point, without controlling or monitoring behavior or providing follow-up.ResultsA total of 11,994 patient days over 18months were included. Combined characteristics: Age: 56.7, 66% male, 96% survival, APACHE II 14 (IQR: 11-19), mechanical ventilation (MV) (occurrences)/patient admission: mean 0.7 (SD: 0.6; range: 0-5), duration (hours) of MV: 21.7 (IQR: 9.8-81.4) and ICU LOS (days): 2.8 (IQR: 1.8-5.6). Average pCXR rate/patient/day before was 0.93 (95% CI: 0.89-0.96), and 0.73 (95% CI: 0.69-0.77) after. Controlling for severity, daily pCXR rate decreased by 21.7% (p<0.001), then increased by about 3%/month (p=0.044). There was no change in APACHE II, mortality, and occurrences or duration of MV, unplanned re-intubations, ICU LOS.ConclusionsIn critically ill adults, pCXR reduction can be achieved in cardiothoracic and trauma/surgical patients with a pragmatic intervention, without adversely affecting patient care, outside a controlled study.Copyright © 2017 Elsevier Inc. All rights reserved.

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