SHM Converge Scientific Abstract ePoster Gallery-Pocus-Guided Tte Triage Protocol to Reduce Inpatient Tte Overutilization

Pdf Summary

This project evaluated whether point-of-care ultrasound (POCUS) could be used to triage inpatient transthoracic echocardiography (TTE) orders and reduce unnecessary testing. The background motivating the study was that TTE is important for cardiac evaluation in hospitalized patients but can increase length of stay; at the study institution, only 40% of medicine-service inpatient TTEs were completed within 24 hours from January to October 2023.<br /><br />The team developed an interdisciplinary POCUS-guided TTE triage protocol for selected adult patients on medicine or cardiology services. Eligible indications included lower-risk scenarios such as low-risk chest pain, decompensated heart failure with a recent TTE, or dyspnea with an alternative explanation. Patients were excluded if they had conditions requiring a full formal TTE, such as congenital heart disease, prosthetic valves, LVADs, or indications like endocarditis, stroke, or pre/post-cardiac surgery evaluation. The workflow included a limited cardiac POCUS exam (PLAX, PSAX, apical and subcostal views, plus IVC), followed by a recommendation to defer/cancel inpatient TTE, obtain it inpatient, or escalate to STAT.<br /><br />Survey data suggested clinicians were generally open to using POCUS for triage, with moderate agreement that it could help inpatient care and diagnostic testing occur more timely. In completed exams, both hospitalists and cardiologists frequently found images interpretable enough to guide decisions. Hospitalists most often recommended deferring TTE to outpatient or not needing formal TTE, while cardiologists more often concluded that formal TTE was not needed.<br /><br />Overall, the findings suggest that a POCUS-guided TTE triage protocol is feasible and may reduce inpatient TTE utilization while speeding completion of needed studies.

Asset Subtitle

Benjamin Hoemann

Meta Tag

Author List Benjamin Hoemann, Crystal Atwood, Jing Li, Karl Wallenkampf, Maya Fiore, Mohamed Ramadan, Mustafa Husaini, Stephanie Conner

Category Innovations

Concept Point-of-Care Ultrasound

Concept Transthoracic Echocardiography

Concept Triage Protocol

Concept Inpatient Transthoracic Echocardiography

Concept Patient Selection Criteria

Distinguished Non-Finalist

Presenter Organization Washington University in St. Louis

Presenting Author Benjamin Hoemann

Track Technology in Hospital Medicine

Keywords

point-of-care ultrasound

POCUS

transthoracic echocardiography

TTE triage

inpatient echocardiography

cardiac ultrasound

hospitalized patients

diagnostic testing

ultrasound protocol

length of stay

Point-of-Care Ultrasound

Transthoracic Echocardiography

Triage Protocol

Inpatient Transthoracic Echocardiography

Patient Selection Criteria