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

Publication ,  Journal Article
Boggan, JC; Schulteis, RD; Donahue, M; Simel, DL
Published in: BMJ Qual Saf
January 2016

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.

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Published In

BMJ Qual Saf

DOI

EISSN

2044-5423

Publication Date

January 2016

Volume

25

Issue

1

Start / End Page

57 / 62

Location

England

Related Subject Headings

  • Unnecessary Procedures
  • Tertiary Care Centers
  • Practice Patterns, Physicians'
  • Natriuretic Peptide, Brain
  • Humans
  • Health Policy & Services
  • Guideline Adherence
  • Echocardiography
  • Decision Making, Computer-Assisted
  • 1302 Curriculum and Pedagogy
 

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Boggan, J. C., Schulteis, R. D., Donahue, M., & Simel, D. L. (2016). Guideline-based decision support has a small, non-sustained effect on transthoracic echocardiography ordering frequency. BMJ Qual Saf, 25(1), 57–62. https://doi.org/10.1136/bmjqs-2015-004284
Boggan, Joel C., Ryan D. Schulteis, Mark Donahue, and David L. Simel. “Guideline-based decision support has a small, non-sustained effect on transthoracic echocardiography ordering frequency.BMJ Qual Saf 25, no. 1 (January 2016): 57–62. https://doi.org/10.1136/bmjqs-2015-004284.
Boggan JC, Schulteis RD, Donahue M, Simel DL. Guideline-based decision support has a small, non-sustained effect on transthoracic echocardiography ordering frequency. BMJ Qual Saf. 2016 Jan;25(1):57–62.
Boggan, Joel C., et al. “Guideline-based decision support has a small, non-sustained effect on transthoracic echocardiography ordering frequency.BMJ Qual Saf, vol. 25, no. 1, Jan. 2016, pp. 57–62. Pubmed, doi:10.1136/bmjqs-2015-004284.
Boggan JC, Schulteis RD, Donahue M, Simel DL. Guideline-based decision support has a small, non-sustained effect on transthoracic echocardiography ordering frequency. BMJ Qual Saf. 2016 Jan;25(1):57–62.

Published In

BMJ Qual Saf

DOI

EISSN

2044-5423

Publication Date

January 2016

Volume

25

Issue

1

Start / End Page

57 / 62

Location

England

Related Subject Headings

  • Unnecessary Procedures
  • Tertiary Care Centers
  • Practice Patterns, Physicians'
  • Natriuretic Peptide, Brain
  • Humans
  • Health Policy & Services
  • Guideline Adherence
  • Echocardiography
  • Decision Making, Computer-Assisted
  • 1302 Curriculum and Pedagogy