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.
Corey Rearick, MD, Joe Weber, MD, supported by a multidisciplinary team.,
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/