Bedside chest radiography as part of a postcardiac surgery critical care pathway: A means of decreasing utilization without adverse clinical impact

Objective: To evaluate the use of bedside chest radiography and patient out come before and after implementation of a cardiac surgery critical care pat hway that included guidelines for bedside radiography. Design: A cohort obs ervational study, Setting: A university hospital in the midwest. Patients: Three groups, of 100 patients each, undergoing cardiac surgery in 1990, 1991, and 1995, Intervention: Introduction of a critical care pathway. Measurements: Medical records were retrospectively reviewed in three groups of 100 patients each: before the introduction of the critical care pathway ; 2 months after introduction of the pathway in 1991; and 4 yrs after intro duction in 1995, Data were analyzed to determine operative risk for each gr oup, Subsequent analyses determined bedside radiography use, total length o f hospital stay, and patient outcome (mortality rate, complications requiri ng intervention, and reoperation) during hospitalization and at outpatient follow-up 15-30 days postdischarge, Results: Total length of hospital stay was shorter for the 1995 group (7.6 +/- 6.6 days) compared with other groups (prepathway, 11.1 +/- 10.3 days; 1 991 postpathway, 10.2 +/- 9.6 days; p < .05), The mean numbers of radiograp hs per patient were as follows: prepathway, 5,1; 1991 postpathway, 5.2; and 1995 postpathway, 3.3, The mean number of radiographs in the 1995 group wa s significantly lower (p = .02). More patients had the proposed number of t wo bedside radiographs described in the pathway in the 1995 group compared with the other groups (prepathway, p < .0001;the two-month postpathway grou p, p = .01). Twenty-three malpositioned catheters/tubes were found in the p repathway and 1991 groups compared with 11 in the 1995 group (p = .02), No statistically significant difference was found in inpatient complications ( mediastinal bleeding, pneumothoraces, and pleural effusions), postdischarge complications, reoperations, or mortality rate. Conclusion: Introduction of a critical care pathway can decrease the use of bedside radiography without adversely affecting near-term patient outcomes .