Holiday

Despite my last post about the importance of laboratory tests and X-rays in the ICU, I am a big proponent of lab or X-ray holidays. One of my secret passions is scouring each patient's orders and reducing unnecessary labs. For example, liver function tests are often checked daily for ICU patients, but if they are normal and the issue has nothing to do with the liver, then why check them at all? Occasionally in a bleeding patient, we trend hematocrits so frequently that I think the blood draws are making the patients anemic. I also think daily chest X-rays are usually overkill. There are a fascinating story (or urban legend) that at a hospital nearby, radiology techs went on strike so only on-demand X-rays could be ordered. Routine daily films were canceled. There were no bad outcomes for patients. This has also been studied formally and the conclusion is that routine X-rays may be costly and unnecessary. So even in the ICU, I try to be as much a minimalist as I can.