Heterogeneity of Electroconvulsive Therapy Practice Under a Common Guideline: Results From a Large Electronic Health...

Consistency in electroconvulsive therapy (ECT) practice across ECT facilities is a critical part of treatment quality.

We studied consistency in clinical and technical ECT variables across 5 adult psychiatric departments operating under the same ECT guideline in the Capital Region of Denmark, 2017-2024. The data set was based on the extraction of structured data from electronic health records in the first ECT series of each individual. The data set included 3343 unique patients and 41,909 ECT procedures.

We found considerable heterogeneity in indications for ECT, as well as in dosing of the charge across departments with fluctuations over time, for example, an up to 2-fold difference in age-adjusted charge at the first ECT and a 4-fold difference in charge at the 10th ECT across departments. In addition, we found substantial variation in reported seizure adequacy and seizure duration. Interestingly, seizure duration was the highest in the department that used the lowest overall charge. Anesthetic dose and number of ECTs in the series did not substantially differ. Based on the available ratings, ECT was highly effective, with a mean Hamilton Depression Rating Scale 17-item across departments in patients with depression ranging from 25.8 (5.6) to 26.8 (6.7) points pre-ECT to 13 (10.1) to 15.1 (9) points post-ECT.

Despite operating under the same guideline, considerable variation in ECT practice is evident across departments and time. Because similar heterogeneity likely exists in other hospitals, organizations, and countries, these data can inform and encourage the development of treatment quality databases and decision support tools in ECT to increase treatment consistency and quality.