Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Martha Biddle

Clinical Mentor

Dr. Peter Morris

Committee Member

Dr. Sheila Melander


Routine daily chest x-rays (CXRs) and laboratory studies have been identified as low-value care practices that contribute to the rising cost of healthcare without improving quality or outcomes. There is a large body of evidence as well as recommendations from multiple professional organizations for providers to not order unnecessary daily or routine diagnostic studies. Rather, these should be ordered in an on-demand fashion as a response to a specific clinical query. Despite the strength of recommendations, practice remains variable across the U.S. The reasons for resistance to practice change as well as the most effective strategies for implementing sustainable change are not well understood. The purpose of this quality improvement project is to evaluate the impact of a multifaceted intervention on the number of routine or daily chest x-rays and laboratory studies ordered by advanced practice providers and medical residents in a medical intensive care unit (MICU). The project aims are to 1) examine baseline ordering practices among MICU providers, 2) survey their knowledge, confidence, beliefs, and barriers surrounding daily diagnostic testing, 3) provide education to providers on current clinical guidelines, 4) implement the guidelines through the use of a clinical decision support tool, and 5) assess provider ordering practices post intervention . The primary outcome is to decrease the number of daily CXRs, BMPs, CBCs, and ABGs ordered unnecessarily in a medical intensive care unit.