Reducing Unnecessary Chest X-Rays After Thoracic Surgery: A Quality Improvement Initiative

Abstract Background Previous work has identified that inpatient post-thoracic surgery chest x-rays (CXR) are overutilized. Methods A 3-phase rapid cycle quality improvement (QI) initiative was performed to reduce empiric post-thoracic surgery CXR use by 25% over one year. We adapted evidence-based guidelines and implemented plan-do-study-act (PDSA) cycle methodology. PDSA cycles included: 1) Education with literature and pre-intervention statistics, 2) Electronic medical record order-set modification, and 3) Audit and feedback with monthly status reports. Each cycle lasted three months. CXR utilization was tracked in the post-anesthesia care unit (PACU) and as a daily rate of non-PACU CXRs. Cost data were estimated from CMS fees. Results During the initiative, 292 thoracic surgery inpatients were monitored. Prior to intervention, 99% (69/70) of patients received a PACU CXR and the daily rate of other CXRs was 1.6. Overall, there was a significant reduction in CXR utilization (p Conclusions Implementation of our QI initiative safely and systematically reduced empiric CXR use after inpatient thoracic surgery. Results will be used in future QI initiatives to reduce unnecessary postoperative testing.