"Echo pause" for postoperative transthoracic echocardiographic surveillance

Area of Science:

• Cardiology
• Medical Imaging
• Health Services Research

Background:

• Current guidelines are lacking for inpatient postoperative transthoracic echocardiographic (TTE) surveillance in congenital heart disease (CHD) patients.
• Prospective evaluation of TTE indications was performed to identify areas for improvement in postoperative CHD care.
• A pilot intervention was assessed to impact the utilization of TTEs in this patient population.

Purpose of the Study:

• To evaluate indications for postoperative TTEs in CHD patients.
• To identify and reduce potentially redundant TTEs during inpatient postoperative surveillance.
• To assess the impact of a simple 'Echo Pause' intervention on TTE utilization.

Main Methods:

• Patients with Risk Adjustment for Congenital Heart Surgery (RACHS-1) scores of 2 and 3 were included for cohort homogeneity.
• Phase 1 involved prospective data collection to identify TTEs with no new findings or clinical management decisions ('potentially redundant').
• Phase 2 implemented an 'Echo Pause' during rounds before TTE orders to prompt review of prior results and indications, comparing redundant TTE rates.

Main Results:

• During Phase 1, 14% (14/98) of postoperative TTEs were identified as potentially redundant, primarily for pericardial effusion evaluation or routine follow-up without clinical change.
• Following the 'Echo Pause' intervention in Phase 2, the rate of potentially redundant TTEs decreased significantly to 5% (5/101) (P = .026).
• The intervention was applied to 101 TTEs across 63 patients, demonstrating a marked reduction in unnecessary imaging.

Conclusions:

• A simple 'Echo Pause' intervention during inpatient rounds can effectively decrease the number of potentially redundant transthoracic echocardiographic surveillance studies in postoperative congenital heart disease patients.
• This strategy offers a practical approach to optimize TTE utilization and potentially reduce healthcare costs associated with unnecessary diagnostic imaging.
• Further implementation of such interventions may improve the efficiency and appropriateness of postoperative cardiac imaging protocols.