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Related Experiment Videos

Clinical Practice Guidelines Decrease Unnecessary Echocardiograms Before Hip Fracture Surgery.

Chris Adair1, Eric Swart, Rachel Seymour

  • 11Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina.

The Journal of Bone and Joint Surgery. American Volume
|April 19, 2017
PubMed
Summary
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Preoperative transthoracic echocardiography (TTE) for hip fracture patients is often not aligned with clinical practice guidelines (CPGs). Adhering to guidelines can reduce unnecessary TTE use without missing critical cardiac conditions.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Anesthesiology

Background:

  • Preoperative transthoracic echocardiography (TTE) for geriatric hip fracture patients is resource-intensive and can delay surgery.
  • Current utilization patterns of TTE in this population are not well-defined.
  • The study addresses the need to optimize TTE use in preoperative cardiac assessment.

Purpose of the Study:

  • To evaluate preoperative TTE utilization in geriatric hip fracture patients.
  • To determine adherence to clinical practice guidelines (CPGs) for TTE ordering.
  • To assess the impact of CPG adherence on resource utilization and detection of actionable cardiac disease.

Main Methods:

  • Retrospective review of 100 geriatric hip fracture patients who underwent preoperative TTE.

Related Experiment Videos

  • Evaluation of TTE ordering against American College of Cardiology/American Heart Association (ACC/AHA) CPGs.
  • Analysis of TTE reports for clinically significant cardiac findings impacting management.

    • Main Results:

    • TTE was ordered according to ACC/AHA CPGs in 66% of patients.
    • Clinically significant cardiac disease, altering management, was found in 14% of patients, all indicated by guidelines.
    • Following CPGs could have prevented 34% of TTEs without missing important disease (40% specificity).

    Conclusions:

    • Preoperative TTE for hip fracture patients is frequently used outside established CPG recommendations.
    • Implementing ACC/AHA guidelines can decrease variability in care and reduce unnecessary resource utilization.
    • Adherence to CPGs for TTE may optimize patient management and resource allocation without compromising outcomes.