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Efficacy, Education, Administration, Informatics

E2337. Efficacy/Cost-Effectiveness of Chest X-Rays Performed for Routine Admission: Review of 4483 Patients

Chowdhary V,  Raia C. Staten Island University Hospital, Northwell Health, Staten Island, NY

Address correspondence to V. Chowdhary (varunchowdhary1@gmail.com)

Objective: At a single institution, more than 4400 chest radiographs were performed for an indication of baseline or admission over the past 1 year. No symptomatic reason was provided for the examination. Furthermore, baseline or admission is not a billable indication. This study will evaluate the utility and cost-effectiveness of performing chest radiographs for an indication of baseline or admission.

Materials and Methods: A retrospective review was performed at a single institution from August 2015 to August 2016. Inclusion criteria were chest radiographs performed over the past 1 year with an indication of baseline/admission. Exclusion criteria included those for which additional symptoms were provided (i.e., pain). Next, patients were divided into four groups. The first were those with no acute findings on chest radiography. The second were those with stable or improved findings. The third were those with findings compatible with known diseases. The fourth were those with new findings that were not previously described. Analysis was then performed to determine the utility and loss of revenue.

Results: A total of 4413 patients were analyzed. Of these, 84.1% were without any acute findings (group 1, n = 3710). Group 2 encompassed 5.5% (n = 195 for stable findings; n = 49 for improved findings). Group 3, those with known disease, contained 4.1% of patients (n = 183). On retrospective chart review of patients’ past medical history, which was not given as an indication at the time of examination, it was found that 42.1% were patients with congestive heart failure, 41.5% had a known mass or lesion, and 16.4% had documented pneumonia. Group 4 contained 276 (6.3%) patients. Within this group, the finding was transient (i.e., resolved on subsequent chest radiograph) in 82 patients. Additionally, within group 4, questionable findings requiring further workup that was subsequently negative was present in 47 patients. Also within group 4 were those patients in which the findings were found to be pulmonary embolism (n = 12) or mass or lesion (n = 12). Within group 4, there were 123 nonspecific findings of which 61.8% had no presenting chest-related symptoms on retrospective medical record chart review. Overall, after performing retrospective chart review for possible chest-related symptoms that were not used to request the chest radiograph, new findings in patients were found in 2.6% (specifically, an incidental mass was found in 0.3%). From a financial standpoint, the global payment of a one-view chest radiograph in 2016 was $22.75. In our cohort, that amounts to approximately $100,400 and equates to the loss of revenue by using baseline/admission as the clinical indication of the chest radiograph.

Conclusion: The vast majority of chest radiographs done for baseline/admission demonstrate no acute findings. If lack of chest-related symptoms are taken into account, then the clinical significance is diminutive. Additionally, since baseline/admission is not a billable or appropriate indication, there is a large amount of revenue that is lost. Several nonquantitative factors such as technologist’s time, transportation, and use of the radiography machine also need to be taken into account.