Children's National quality initiative reduces NICU chest X-rays, cuts costs

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A quality improvement initiative implemented at Washington, D.C.-based Children's National Health System successfully reduced the number of chest X-rays conducted in the neonatal intensive care unit, decreasing the risk of errors and cutting costs, according to research presented Sept. 15 at the 2017 American Academy of Pediatrics national conference in Chicago.

The updated NICU X-ray protocol represented part of a larger initiative to reduce unintended extubations, which occur when an infant's breathing tube accidentally pops out. Chest X-rays increase the likelihood of this adverse event.

Before the intervention, newborns underwent an average of 0.45 chest X-rays per patient day. After the program was implemented in July 2015, that figure dropped to 0.23 chest X-rays per patient day. Additionally, by the end of 2015, the NICU monthly X-ray spend dropped from $289,520 to $159,424, producing nearly $1.6 million in annual savings.

"When you reduce the frequency of patients in the unit being moved, you decrease the chances of the breathing tube coming out accidentally," said Michelande Ridoré, program lead in Children's division of neonatology, who presented the research at the AAP conference. "By reducing unplanned extubations in the NICU, we can improve overall clinical outcomes, reduce length of stay, lower costs and improve patient satisfaction."

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