SHM Converge Scientific Abstract ePoster Gallery-Echoes of Efficiency: Reducing Carotid Doppler Overuse in a Community Teaching Hospital

Pdf Summary

This project examined and reduced overuse of carotid Doppler ultrasound at a community teaching hospital. Carotid Doppler is appropriate when there is concern for stroke, transient ischemic attack (TIA), focal neurologic deficits, or carotid bruits, but it is not recommended for patients with syncope alone. National guidelines from the American Academy of Neurology and the US Preventive Services Task Force advise against using carotid Doppler for isolated syncope because carotid stenosis does not cause syncope in the absence of neurologic symptoms.<br /><br />A pre-intervention audit from January 2020 to July 2021 found 857 carotid Doppler studies, with only 63 showing mild carotid stenosis as an incidental finding and just 2 cases leading to carotid endarterectomy, demonstrating low diagnostic yield. In August 2021, the hospital implemented an intervention involving Neurology, Cardiology, Radiology, and Hospital Medicine. The strategy included evidence-based ordering criteria, provider education, technologist review of inappropriate orders, escalation when needed, and weekly audit feedback.<br /><br />The intervention was highly effective: annual carotid Doppler orders fell by 91%, from 706 in 2019 to 60 in 2024, with sustained reduction through 2024. The program also improved care efficiency by reducing excess days and length of stay among patients admitted with syncope and collapse. The authors suggest expanding this approach to other potentially overused services such as echocardiography, medications, and pre-operative testing.

Asset Subtitle

Rishi Malhan

Meta Tag

Author List Bryant Faria, David Leicht, John Raimo, Rishi Malhan

Category Innovations

Concept Doppler Ultrasound

Concept Stroke

Concept Transient Ischemic Attack

Concept Focal Neurologic Deficit

Concept Carotid Artery Disease

Distinguished Non-Finalist

Presenter Organization Northwell Health

Presenting Author Rishi Malhan

Track Value in Hospital Medicine

Keywords

carotid Doppler ultrasound

overuse reduction

syncope

stroke evaluation

transient ischemic attack

neurologic deficits

carotid bruits

clinical guidelines

quality improvement

hospital audit

Doppler Ultrasound

Stroke

Transient Ischemic Attack

Focal Neurologic Deficit

Carotid Artery Disease