Original Contribution  |   May 2018
Laboratory Tests and X-ray Imaging in a Surgical Intensive Care Unit: Checking the Checklist
Author Notes
  • From the Division of Acute Care Surgery at the University of Florida College of Medicine in Jacksonville (Dr Yorkgitis), the Surgical ICU Translational Research Center (Mr Loughlin, Mr Gandee, and Ms Bates), and the Division of Pulmonary and Critical Care (Dr Weinhouse) at the Brigham and Women's Hospital in Boston, Massachusetts. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Brian K. Yorkgitis, DO, University of Florida College of Medicine, Division of Acute Care Surgery, 655 W 8th St, Jacksonville, FL 32209-6511. Email: brian.yorkgitis2@jax.ufl.edu
     
Article Information
Emergency Medicine / Imaging
Original Contribution   |   May 2018
Laboratory Tests and X-ray Imaging in a Surgical Intensive Care Unit: Checking the Checklist
The Journal of the American Osteopathic Association, May 2018, Vol. 118, 305-309. doi:10.7556/jaoa.2018.060
The Journal of the American Osteopathic Association, May 2018, Vol. 118, 305-309. doi:10.7556/jaoa.2018.060
Abstract

Context: Patients in the surgical intensive care unit (ICU) frequently undergo laboratory and imaging testing. These tests can lead to iatrogenic anemia and radiation exposure. Many of these tests may be unnecessary for the management of a patient's illness in the surgical ICU, and their ordering may be a reflex rather than in response to a clinical question. Checklists have been used in critical care to identify and address patient care strategies.

Objective: To examine whether adding a “diagnostic testing” section to a daily checklist used for patient rounds in a surgical ICU would decrease the amount of laboratory tests and chest x-ray imaging ordered.

Methods: An additional section was added to an established ICU daily checklist, which included the following 2 questions: “Is a [chest x-ray] needed for clinical management tomorrow?” and “What laboratory tests are medically necessary for tomorrow?” Comparison was made between 3-month preintervention (control group) and intervention (intervention group) periods. Medical records of hospitalized patients during the preintervention and intervention periods were compared to determine differences in the number of tests ordered per day during each period.

Results: A total of 307 adult patients at a single institution were included in the analysis: 155 in the control group and 152 in the intervention group. The patients in each group were similar in terms of sex, age, Sequential Organ Failure scores, Charlson Comorbidity Index scores, elective admission status, surgical procedures, number of days of mechanical ventilation, ICU length of stay, and in-hospital death. No statistical reductions in laboratory tests or chest x-ray imaging ordered per day from the preintervention to intervention period were found.

Conclusion: The addition of the diagnostic testing section to the daily checklist did not result in a reduction of the amount of tests ordered per day. Further research on test appropriateness and the possible addition of a clinician decision-making tool could be studied in the future to assist with reduction of tests ordered in the surgical ICU.

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