HDSI Project
Reducing Inappropriate Use Of Outpatient Transthoracic Echocardiography
The project aims to educate staff and create Epic-based tools to inform when a TTE may not be clinically indicated. The project will compare TTE utilization, cost, and wait times before and after this campaign to determine efficacy.
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Appropriate Use Criteria for Transthoracic Echocardiography
The American Society of Echocardiography (ASE) defined appropriate use of transthoracic echocardiography (TTE) as “appropriate, maybe appropriate, and rarely appropriate.”
The following are 3 (of many) instances in which TTE was determined to be rarely appropriate. They are listed herein for purposes of education only and should not deter a provider from ordering a study that they deem necessary.
In sequential or follow-up testing of asymptomatic or stable patients, rarely appropriate indications for TTE consisted of:
- Re-evaluation at <1 year of ejection fraction in a patient at risk for heart failure (HF) without structural heart disease on prior TTE and no change in clinical status or cardiac examination
- Re-evaluation at <1 year of known hypertensive heart disease without a change in clinical status or cardiac examination
- Re-evaluation at <1 year of cardiomyopathy (systolic or diastolic) or HF without a change in clinical status or cardiac examination
Rarely appropriate use of TTE is further defined as: “Rarely an appropriate option for management of patients in this population due to the lack of a clear benefit/risk advantage; rarely an effective option for individual care plans; exceptions should have documentation of the clinical reasons for proceeding with this care option.”
Link to ASE Guidelines: https://www.asecho.org/appropriate-use-criteria/