Limited Echocardiography as an Economic Alternative to Complete Studies for Selected Inpatients

Background Echocardiography can be a useful tool in diagnosis and guiding therapy in cardiovascular diseases. However, repeating studies without change in clinical status is inappropriate and not cost effective. This is frequently seen in heart failure patients on readmission. The goal of this study was to identify repeat studies which did not meet appropriateness criteria and identify ways to reduce the institutional burden of such studies. Methods A cross sectional review was performed on 915 inpatient transthoracic echocardiograms between the dates of August 1, 2017 through August 31, 2017. All studies performed at our institution during these dates were reviewed. Studies were placed into one of three categories based on the date of their most recent previous echocardiogram: one week, 8-30 days, and 31-90 days. Indications were identified for each repeat study and deemed appropriate based on clinical situation. Appropriate complete repeat studies included: cardiac arrest, cardiac surgery, and significant arrhythmia (ventricular tachycardia or fibrillation). Results Of the 915 inpatient transthoracic echocardiograms performed at our institution during a one month period, 18.3% (167/915) had a complete transthoracic echocardiogram done within the last three months. 26.3% (44/167) of the repeat studies were in the previous 31 to 90 days. 73.7% (123/167) had studies within the last 30 days, and 37.7% (63/167) were in the last 7 days. 33.5% (56/167) were limited studies. 13.8% (23/167) had appropriate indications for complete repeat study. 46.7% (78/167) of complete repeat exams could have been considered for a limited exam instead of complete exam or avoided. 8.5% (78/915) total studies could have been considered for a limited exam instead of complete exam or avoided. 24.0% (40/167) of repeated studies with had an indication listed as “congestive heart failure” or “cardiomyopathy”, with the majority of these studies being repeated within one month. Conclusions Limited echocardiography is more cost effective than repeating complete studies on inpatients who have had a recent complete echocardiogram and should be considered as an alternative. Evaluating change in left ventricular ejection fraction is an excellent use of limited echocardiography. We propose a new tool in the electronic medical record to prompt providers to consider this when ordering ultrasound exams on their patients.