PC2182: Reducing Radiation Exposure in Neonates in the NICU

Purpose/Objectives: In 2018, the “babygram” was a common occurrence in our military NICU. Through baseline assessment, we found that nearly 80% of NICU x-ray images included both a full chest and abdomen, regardless of the indication for obtaining the film. As most x-rays in the NICU are aimed at examining lung fields, unindicated babygrams and inadequate collimation leads to unnecessary radiation for infants. Our quality improvement goal is to strive for the ALARA principle – as low as reasonably achievable. If receiving even a small dose of radiation has no direct benefit, it should be avoided. Our objective was to decrease unnecessary radiation exposure for neonates in the NICU.

Design/Methods: Baseline data was obtained to begin Plan, Do, Study, Act (PDSA) Cycle One. Process measures were identified as percentage of images with appropriate indication provided and percentage of images with a matching order and image obtained. Balancing measures were identified as number of images obtained per order and if the stomach bubble was visible in the chest x-ray. Each cycle is comprised of an intervention, followed by a two-month review of images to collect data, and a comparison to baseline. New interventions are made as necessary based on results of data collection. There was a lapse due to impact in project personnel and high turnover of ancillary staff in the military NICU during COVID-19, which ultimately allowed for assessment of sustainability of previous improvements and to identify potential new areas of improvement.

Results: Over time, through repeated education with increasingly specific goals, we have been able to demonstrate marked improvement. Re-analysis of baseline data following a gap of time demonstrated a sustainability regarding correct indication for the image obtained (90% from previous 93%) and male gonads included in image (2.7% from previous 0%). Areas that remained problematic included: increase in the frequency of babygrams obtained (20% up to 53%) and a decrease in the percentage of images obtained that matched the order (100% down to 62%). It was identified that 44% of our images were of lower quality due to placement of leads on the chest or abdomen obscuring the view.

Conclusion/Discussion: Initial goals were met for the first two PDSA cycles, after which there was a large impact on the project due to COVID-19. After re-analyzing the data and identifying new areas of improvement, we have continued with subsequent PDSA cycles and are working to ensure sustainability of this project. To be sustainable and have better long-term results, it is imperative that we improve buy-in from other disciplines.