SHM Converge Scientific Abstract ePoster Gallery-Reducing Repeat Transthoracic Echocardiograms in an Inpatient Setting

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This study examined efforts to reduce repeat transthoracic echocardiograms (TTEs) for hospitalized patients at Johns Hopkins Health System. Repeat TTEs, defined as studies performed within one year of a prior exam, make up about 25% of all TTE orders but are often not clinically appropriate. At Johns Hopkins, this created a substantial volume of low-value imaging and resource use.<br /><br />To address this, the team built an electronic medical record best practice alert (BPA) that triggered whenever a clinician ordered a TTE for an inpatient who had already had a TTE within the previous 90 days. The alert displayed results from the most recent echo and asked the provider either to proceed or cancel the order. If the provider chose to continue, a free-text reason was required. The BPA excluded patients in the CCU and CVSICU.<br /><br />After implementation, 34.3% of clinicians chose to discontinue the repeat TTE, reducing repeat orders by about one third. Internal Medicine placed the highest number of repeat orders, followed by medicine subspecialties. Common override reasons included change in clinical status, pericardial effusion, bacteremia, infective endocarditis, and acute decompensated heart failure, with several of these judged appropriate or conditionally appropriate by echocardiography use criteria.<br /><br />Importantly, the intervention did not appear to worsen balancing outcomes. Thirty-day readmission rates were similar between patients who continued versus canceled the repeat TTE order (20% vs. 19%, p=0.88), and length of stay was also not significantly different (11.4 vs. 9.3 days, p=0.41).<br /><br />Overall, the BPA successfully reduced unnecessary repeat TTEs without increasing readmissions or length of stay, suggesting that EMR-based decision support can improve efficiency and resource allocation in inpatient care.

Asset Subtitle

Becca C. Engels

Meta Tag

Author List Allison Hays, Amit K. Pahwa, Becca C. Engels, Eamon Duffy, Ken Lee, Sara C. Keller, Stacie Richardson

Category Research

Concept Transthoracic Echocardiography

Concept Repeat Imaging

Concept Best Practice Alert

Concept Appropriateness Criteria

Concept Low-Value Care

Distinguished Non-Finalist

Presenter Organization Johns Hopkins University School of Medicine

Presenting Author Becca C. Engels

Track Quality Improvement

Keywords

transthoracic echocardiogram

repeat imaging

best practice alert

electronic medical record

inpatient care

resource utilization

decision support

readmission rate

length of stay

Johns Hopkins

Transthoracic Echocardiography

Repeat Imaging

Best Practice Alert

Appropriateness Criteria

Low-Value Care