Don’t order routine investigations including chest radiographs or blood tests in critically ill patients, except to answer a specific clinical question.

Chest radiographs (“X-rays”, CXRs) are not indicated for routine assessment of critically-ill patients except when indicated for specific procedures (e.g., endotracheal tube, naso- or orogastric tube, central vein catheter, pulmonary artery catheter, or other procedure requiring verification after insertion), or to provide information for a specific question related to a change in patient’s clinical condition, and if the information will likely impact a specific decision related to diagnosis or treatment.

Sources:

Ganapathy A, et al. Routine chest x-rays in intensive care units: a systematic review and meta-analysis. Crit Care. 2012 Dec 12;16(2):R68. PMID: 22541022.

Eaton KP et al. Evidence-based guidelines to eliminate repetitive laboratory testing. JAMA Intern Med. 2017;177(12):1833-9. PMID: 29049500. PMID: 29049500

Kotecha N et al. Reducing Unnecessary Laboratory Testing in the Medical ICU. Am J Med. 2017 Jun;130(6):648-651. PMID: 28285068

Routine Blood Tests for Patients in the Intensive Care Unit: Clinical Effectiveness, Cost-Effectiveness, and Guidelines. CADTH. August 16, 2013