SHM Converge Scientific Abstract ePoster Gallery-Reducing Echocardiograms in Patients With Simple Syncope

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This quality improvement project addressed overuse of transthoracic echocardiography (TTE) in patients admitted with simple syncope. Current guidelines recommend against routine cardiac imaging unless there is clinical suspicion of a cardiac cause, based on history, physical exam, or ECG findings. At the study hospital, many TTEs were found to be inappropriate, contributing to unnecessary cost and longer hospital stays.<br /><br />The team conducted a retrospective review of syncope admissions with TTEs from January 1 to July 9, 2023. TTEs were considered inappropriate if patients had no heart failure symptoms, new murmurs, ECG changes, or significant cardiac history. The project goal was to reduce unnecessary TTEs by 30% between July 9, 2023 and June 30, 2024.<br /><br />Two PDSA cycles were implemented. The first included formal educational sessions for hospitalists and residents during conferences. The second targeted residents and interns on night shifts and staff in the observation unit. Educational posters were also placed in work areas as reminders.<br /><br />Before the intervention, the TTE order rate was 2.42 per 1,000 patient care days, and 88.5% of these studies were inappropriate. After the interventions, the rate fell to 1.37 per 1,000 patient care days, representing a 43.4% reduction. Average length of stay for syncope encounters also decreased from 5.02 days to 4.16 days.<br /><br />Overall, targeted education and visual prompts effectively reduced unnecessary inpatient TTE use for syncope and shortened hospital stays, improving resource utilization at a safety-net hospital.

Asset Subtitle

Harleen Sidhu

Meta Tag

Author List Avery Hum, Harleen Sidhu, Joy Kim

Category Research

Concept Transthoracic Echocardiography

Concept Syncope

Concept History

Concept Physical Examination

Concept Electrocardiogram

Distinguished Non-Finalist

Presenter Organization Department of Medicine, NYC Health + Hospitals/ Elmhurst, Icahn School of Medicine at Mount Sinai

Presenting Author Harleen Sidhu

Track Quality Improvement

Keywords

syncope

transthoracic echocardiography

TTE overuse

quality improvement

inappropriate imaging

PDSA cycle

hospitalist education

residents and interns

length of stay

resource utilization

Transthoracic Echocardiography

Syncope

History

Physical Examination

Electrocardiogram