{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:34:35Z","timestamp":1788222875274,"version":"build-2803163510"},"reference-count":22,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2023,3,17]],"date-time":"2023-03-17T00:00:00Z","timestamp":1679011200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The Critical Care Societies Collaborative included not ordering diagnostic tests at regular intervals as one of their Choosing Wisely initiatives. A reduction in unnecessary chest radiographs (CXRs) can help reduce exposure to radiation and eliminate health care waste. We aimed to reduce daily screening CXRs in a pediatric ICU (PICU) by 20% from baseline within 4 months of implementation of CXR criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>All intubated patients in the PICU were included in this quality improvement project. Patients with tracheostomies were excluded. We developed criteria delineating which patients were most likely to benefit from a daily screening CXR, and these criteria were discussed for each patient on rounds. Patients on extracorporeal membrane oxygenation, on high-frequency oscillatory ventilation, or on high support on conventional mechanical ventilation were included as needing a daily screening CXR. We tracked the percentage of intubated subjects receiving a screening CXR as an outcome measure. Unplanned extubations and the number of non-screening CXRs per intubated subject were followed as balancing measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>The percentage of intubated subjects receiving a daily screening CXR was reduced from 79% to 31%. There was no increase in frequency of unplanned extubations or number of non-screening CXRs. With an estimated subject charge of roughly $270 and hospital cost of $54 per CXR, this project led to an estimated $300,000 in patient charge savings and $60,000 in hospital cost savings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Adopting criteria to delineate which patients are most likely to benefit from screening CXRs can lead to a reduction in the percentage of intubated patients receiving screening CXRs without appearing to increase harm.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4187\/respcare.10689","type":"journal-article","created":{"date-parts":[[2023,3,19]],"date-time":"2023-03-19T03:47:33Z","timestamp":1679197653000},"page":"1377-1384","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["A Quality Improvement Initiative to Reduce Unnecessary Screening Chest Radiographs in a Pediatric ICU"],"prefix":"10.1177","volume":"68","author":[{"given":"Stefan W","family":"Malin","sequence":"first","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle K","family":"Maue","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel T","family":"Cater","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimee R","family":"Ealy","sequence":"additional","affiliation":[{"name":"Department of Respiratory Care, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne E","family":"McCallister","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin M","family":"Valentine","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samer M","family":"Abu-Sultaneh","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,3,17]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2012.11.013"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc11321"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2016.09.059"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.1119"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.107.2.241"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pedn.2021.05.012"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/0009922818780696"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e31823c9a26"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199908000-00033"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.10375"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2015455"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.4103\/JETS.JETS_89_19"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.3233\/PIC-14082"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.08347"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000001285"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.08284"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e3181b80951"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021-052089"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13052-022-01221-w"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2021.740785"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000003396"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2020.0268"}],"container-title":["Respiratory 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