Guideline-based decision support has a small, non-sustained effect on transthoracic echocardiography ordering frequency.

Boggan, JC

Schulteis, RD

Donahue, M

Simel, DL

England

2016-05-20T19:44:39Z

2016-01

BACKGROUND: Guidance for appropriate utilisation of transthoracic echocardiograms (TTEs) can be incorporated into ordering prompts, potentially affecting the number of requests. METHODS: We incorporated data from the 2011 Appropriate Use Criteria for Echocardiography, the 2010 National Institute for Clinical Excellence Guideline on Chronic Heart Failure, and American College of Cardiology Choosing Wisely list on TTE use for dyspnoea, oedema and valvular disease into electronic ordering systems at Durham Veterans Affairs Medical Center. Our primary outcome was TTE orders per month. Secondary outcomes included rates of outpatient TTE ordering per 100 visits and frequency of brain natriuretic peptide (BNP) ordering prior to TTE. Outcomes were measured for 20 months before and 12 months after the intervention. RESULTS: The number of TTEs ordered did not decrease (338±32 TTEs/month prior vs 320±33 afterwards, p=0.12). Rates of outpatient TTE ordering decreased minimally post intervention (2.28 per 100 primary care/cardiology visits prior vs 1.99 afterwards, p<0.01). Effects on TTE ordering and ordering rate significantly interacted with time from intervention (p<0.02 for both), as the small initial effects waned after 6 months. The percentage of TTE orders with preceding BNP increased (36.5% prior vs 42.2% after for inpatients, p=0.01; 10.8% prior vs 14.5% after for outpatients, p<0.01). CONCLUSIONS: Ordering prompts for TTEs initially minimally reduced the number of TTEs ordered and increased BNP measurement at a single institution, but the effect on TTEs ordered was likely insignificant from a utilisation standpoint and decayed over time.

http://www.ncbi.nlm.nih.gov/pubmed/26405095

bmjqs-2015-004284

2044-5423

https://hdl.handle.net/10161/12046

eng

BMJ Publishing Group

BMJ Qual Saf

10.1136/bmjqs-2015-004284

Control charts, run charts

Decision support, computerized

Quality improvement

Statistical process control

Decision Making, Computer-Assisted

Echocardiography

Guideline Adherence

Humans

Natriuretic Peptide, Brain

Practice Patterns, Physicians'

Tertiary Care Centers

Unnecessary Procedures

Guideline-based decision support has a small, non-sustained effect on transthoracic echocardiography ordering frequency.

Journal article

Boggan, JC|0000-0003-3564-2807

http://www.ncbi.nlm.nih.gov/pubmed/26405095

57

62

1

Clinical Science Departments

Duke

Medicine

Medicine, General Internal Medicine

School of Medicine

Published

25