Appropriate use intervention helps fellows reduce unneeded echo tests

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Transthoracic echocardiogram use has been on the rise, but is it always appropriate? Not always, but a physician-centered intervention aimed at improving trainees’ adherence to appropriate use criteria appeared to increase appropriate and decrease inappropriate testing.

The study was published online Aug. 13 in the Journal of the American College of Cardiology: Cardiovascular Imaging.

Led by R. Sacha Bhatia, MD, MBA, of Women’s College Hospital in Toronto, the research team provided education and electronic pocket cards to the interventional arm of their randomized controlled trial. Both the control and the intervention were monitored to see the frequency and appropriateness of requesting transthoracic echocardiograms between August 2012 and April 2013.

The research group used the term “inappropriate” as opposed to “rarely appropriate” as the study began prior to the release of updated language by professional groups.

They found that while the interventional group performed 2.7 times fewer inappropriate echocardiograms, they also ordered significantly more appropriate tests (81 percent vs. 58 percent).  A 62 percent reduction in inappropriate echocardiograms was seen in the interventional group.

Bhatia et al noted that six clinical indications accounted for 75 percent of all inappropriate echocardiograms and were all related to patient surveillance.

They cited ongoing investigation into whether or not this sort of intervention was impactful on clinical practice. Bhatia et al also recommended looking into the intervention's impact on patient outcomes and healthcare costs.