Abstract 19632: Appropriate Use of Inpatient Repeat Echocardiography in a Tertiary Care Center

Abstract

Background: Echocardiography is used with increasing frequency to address clinical cardiac questions. With its increasing use, criteria have been promulgated for the appropriate use (AUC) of Echo by the ACC/ASE. Little information currently exists on the inpatient use of transthoracic echocardiography (TTE) when a prior study (repeat) has been performed recently. Our aim was to study the application of 2011 AUC criteria on clinical management for inpatient repeat TTE in a tertiary care center.

Methods: Over a 1-month period in 2012, written requests for 500 consecutive inpatient TTEs were evaluated. The echo database was queried to determine if a TTE had been performed within 1 yr. Indications for repeat TTE were categorized as appropriate (A), uncertain (U) and inappropriate (I) based on AUC criteria. A retrospective chart review was performed to assess impact of the AUC categorized results on clinical management.

Results: Of the 500 TTEs, 131(26%) were repeat studies. Per AUC, 49% were considered A, 17% U and 34% I. Among these repeat TTEs, 53% played a role in clinical management, while 47% had no discernible role. A significant difference was found in clinical management among A, U, I groups (84.4% vs. 50% vs. 8.9%, p<0.0001). Of 131 repeat TTEs, 39(30%) were ordered by cardiology while non- cardiology providers ordered 92(70%). The top 3 indications of (A) TTEs were heart failure (22%), pericardial effusion (15%) and hemodynamic instability (15%), while (I) TTEs were heart failure (26%), syncope (12%) and pericardial effusion (11%). No significant difference was found among cardiology and non-cardiology providers in ordering A, U and I TTEs (41% vs. 53.5%, p=0.4, 20.5% vs. 16.3%, p=0.4 and 38.5% vs. 30.2%, p=0.4).

Conclusions: Approximately one-third of repeat TTEs in a tertiary care medical center can be classified as (I). Noncardiology services were comparable to cardiology providers in applying AUC criteria. In an effort to reduce (I) repeat TTEs, knowledge of prior TTE data and incorporation of AUC criteria into order entry mechanisms should occur to aid inpatient provider decisions on ordering TTEs.