How Soon Is Too Soon? Triaging Inpatient Transthoracic Echocardiogram Orders to Reduce Turnaround Times

Increases in inpatient transthoracic echocardiogram (TTE) orders at our tertiary care center have led to longer image-acquisition times and affected hospital length of stay.

Our data showed that 22.9% of all TTEs ordered in 2023 were designated as pending discharge (PD) priority level in comparison to 6.8% in 2018. There was concern that providers were inappropriately ordering the PD TTE priority in an attempt to bypass the inpatient TTE queue.

Our initial attempt at utilizing flyers to educate providers on PD TTE ordering criteria did not result in improvements. However, within months of implementing an electronic medical record system intervention, we reduced the proportion of PD TTE orders by 14.4% and reduced the mean routine TTE image acquisition time by 49.6%.

An electronic medical record hard stop proved to be a more consistent method in enforcing decision-making and improving the workflow process for appropriate ordering of inpatient TTEs.