Published online Jun 26, 2020. doi: 10.4330/wjc.v12.i6.262
Peer-review started: January 30, 2020
First decision: April 3, 2020
Revised: May 12, 2020
Accepted: May 14, 2020
Article in press: May 14, 2020
Published online: June 26, 2020
Echocardiograms are an incredibly useful diagnostic tool due to their lack of harmful radiation, the relative ease and speed with which they can be performed, and their almost ubiquitous availability. Unfortunately, the advantages that support the use of echocardiography can also lead to the overuse of this technology. We sought to evaluate the physician perceived impact echocardiography has on patient management.
To evaluate the physician perceived impact echocardiography has on patient management.
Surveys were distributed to the ordering physician for echocardiograms performed at our institution over a 10-wk period. Only transthoracic echocardiograms performed on the inpatient service were included. Surveys were distributed to either the attending physician or the resident physician listed on the echocardiogram order. The information requested in the survey focused on the indication for the study and the perceived importance and effect of the study. Observational statistical analysis was performed on all of the answers from the collected surveys.
A total of 103 surveys were obtained and analyzed. The internal medicine (57%) and cardiology (37%) specialties ordered the most echocardiograms. The most common reason for ordering an echocardiogram was to rule out a diagnosis (38.2%). Only 27.5% of physicians reported that the echocardiogram significantly affected patient care, with 18.6% reporting a moderate effect, and 30.4% reporting a mild effect. A total of 19.6% of physicians stated that there was no effect on patient management. Additionally, 43.1% of physicians reported that they made changes in patient management due to no change having occurred in the disease, 11.8% reported that changes in management were based on the recommendation of a specialist, and only 9.8% reported that further imaging was ordered due to the results of the echocardiogram. The majority of physicians (67.6%) considered an echocardiogram to be “somewhat essential” in the management of adult inpatients, with only 15.7% considering it “essential”.
The majority of physicians surveyed report the echocardiogram had only a mild effect on management with only 27.5% reporting a significant effect. However, the majority of physicians (83.3%) perceived an echocardiogram to be somewhat or entirely essential for management. Only 9.8% reported the echo led to further imaging. These insights into ordering physician reasoning should help guide better definition of the optimal and ideal use of echocardiography.
Core tip: The echocardiogram is a useful tool used by cardiologists to manage patients. However, its practicality and availability may result in the overuse of echocardiography in situations where it is not warranted. Such overuse may result in exhaustion of resources and reduced efficiency. Our survey of physicians who ordered an echocardiogram sheds light on the true and perceived usefulness of the echocardiogram in an inpatient setting. The results illustrate physicians’ perception of echocardiography as somewhat or entirely essential for patient management, despite a proportion of reported mild or no effect on patient management.