A Quality Improvement Initiative for Echocardiogram Ordering Patterns in an Academic Hospital

Area of Science:

• Cardiology
• Healthcare Quality Improvement

Background:

• Appropriate Use Criteria (AUC) guide quality healthcare delivery.
• Echocardiography utilization requires adherence to AUC for optimal patient care.
• Transthoracic echocardiograms (TTEs) are frequently utilized diagnostic tools.

Purpose of the Study:

• To assess trends in echocardiography utilization.
• To improve adherence to AUC for TTEs through an interventional study.
• To evaluate the impact of an updated order form on TTE appropriateness.

Main Methods:

• Prospective, time series analysis of inpatient TTEs at Upstate University Hospital (July 2019 vs. August 2020).
• Chart analysis of 620 pre-intervention and 410 post-intervention TTE orders.
• Intervention involved updating the TTE order form with 42 common appropriate indications.

Main Results:

• Pre-intervention appropriate TTE rate was 81%; post-intervention was 79.5% (p=0.55).
• Significant reduction in discordant TTE orders post-intervention (p<0.01).
• Increased appropriateness within the concordant TTE group observed pre- and post-intervention.

Conclusions:

• The intervention significantly improved concordance between TTE order sheets and actual indications.
• Enhanced concordance can lead to improved scanning and reading quality, focusing on true clinical needs.
• No significant increase in overall appropriate TTE utilization was detected.