Abstract 14850: An Educational Intervention Reduces the Rate of Inappropriate Echocardiograms Ordered on an Inpatient Medical Service

Abstract

Background: Appropriate Use Criteria (AUC) for transthoracic echocardiography (TTE) was developed in response to concerns about inappropriate utilization of TTE. Our aim was to prospectively study the impact of an AUC-based educational intervention on TTE ordering among housestaff on the inpatient General Internal Medicine Service at an academic medical center.

Methods: We conducted a prospective, time series analysis of an educational intervention designed to reduce inappropriate TTE ordering from February-May 2012, which was compared to TTE ordering on the same general medical service during a control period (February-May 2011). The intervention consisted of: 1) a lecture to housestaff on the 2011 AUC for TTE, 2) a pocketcard that applies the AUC to common clinical scenrarios and, 3) bimonthly feedback on ordering behavior via email. The primary outcome was the proportion of inappropriate and appropriate TTEs ordered during the intervention period.

Results: 98.2% of all TTEs ordered in the control and study periods were classified as appropriate using the 2011 AUC. During the study period, there was a 29% reduction in the total number of TTEs ordered compared to the control period, (291 vs. 412 TTEs, p<0.001). During the study period, the proportion of inappropriate TTEs was significantly lower (6% vs. 14%, p<0.001; Figure 1) and the proportion of appropriate TTEs was significantly higher (93% vs. 83%, p<0.001).

Conclusions: A simple educational intervention produced a significant reduction in the proportion of inappropriate TTEs and increased the proportion of appropriate TTEs ordered on an inpatient academic medical service. The impact of this type of intervention on clinical outcomes and healthcare costs warrants further study.