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
The transthoracic echocardiogram (TTE) is a cardiovascular imaging tool that is used by doctors and hospitals to evaluate patients in various settings. The TTE is an incredibly useful tool due to the ability to examine the heart non-invasively, as well as the efficiency and lack of risk. Due to its usefulness and ease, it has been known to be overused. This has been recognized by the appropriate use criteria (AUC) and therefore guidelines have been created to limit its overuse. However, it has been perceived that the echocardiogram is still being overused in many settings despite the guidelines.
The topic of this study is to evaluate the perceived impact the TTE has on inpatient management. The overuse of this tool is an example of inappropriate usage of healthcare resources and can lead to improper patient care. Improving utilization of this tool will optimize patient care.
The objective of this study is to better understand the perceived impact that the TTE has on patient management that leads to its continued overuse.
This observational study was conducted by distribution of surveys to physicians at an academic institution. The survey was completed by physicians of multiple hospital departments, who ordered a TTE within a 10 wk period in the inpatient setting. The survey requested information on the perceived importance and impact the TTE had on clinical management.
The most common reason for a physician ordering a TTE was to rule out a diagnosis and to evaluate a known cardiac condition. A total of 19.6% of physicians stated that there was no effect on patient management, 30.4% of physicians reported a mild effect, 18.6% declared a moderate effect, and only 27.5% of physicians reported that the echocardiogram significantly affected patient care. Almost half of physicians reported that they altered their patient management due to no change having occurred in the disease based on TTE findings, 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 considered an echocardiogram to be “somewhat essential” in the management of adult inpatients, with only 15.7% considering it “essential”, and 14.7% chose not to answer this question.
This study reveals that there are a substantial number of physicians who order TTE without proper use despite the AUC guidelines. Many physicians stated in our study that the TTE had only a mild or no effect on patient management but is still perceived to be somewhat or entirely essential to patient care. While the AUC guidelines expectedly did limit an amount of inappropriate use of the TTE, this study better illustrates the actual utility of the TTE after the criteria is implemented. This lack of correlation calls for a new process of TTE utilization review of patient management for inpatient care.
This study revealed the importance of increased optimization of proper echocardiography use. Future research should explore bedside point of care echocardiography which can be performed more efficiently while still providing proper patient management.