An Educational Intervention Reduces the Rate of Inappropriate Echocardiograms on an Inpatient Medical Service

OBJECTIVES This study sought to prospectively study the impact of an appropriate use criteria (AUC)-based educational intervention on transthoracic echocardiography (TIE) ordering among house staff on the inpatient general internal medicine service at an academic medical center. BACKGROUND AUC for TIE were developed in response to concerns about inappropriate use of TIE. To date, educational interventions based on the AUC to reduce inappropriate use of TIT have not been prospectively studied. METHODS A prospective, time series analysis of an educational intervention was conducted and then compared with TIE ordering on the same medical service during a control period. The intervention consisted of: 1) a lecture to house staff on the 2011 AUC for TIE; 2) a pocket card that applied the AUC to common clinical scenarios; and 3) biweekly e-mail feedback regarding ordering behavior. TIE ordering was tracked over the intervention period on a daily basis and feedback reports were e-mailed at 2-week intervals. The primary outcome was the proportion of inappropriate and appropriate TIE ordered during the intervention period. RESULTS Of all TTEs ordered in the control and study periods, 99% and 98%, respectively, were classifiable using the 2011 AUC. During the study period, there was a 26% reduction in the number of TTE ordered per day compared with the number ordered during the control period (2.9 vs. 3.9 TIE, p < 0.001). During the study period, the proportion of inappropriate TIE was significantly lower (5% vs. 13%, p < 0.001) and the proportion of appropriate TIE was significantly higher (93% vs. 84%, p < 0.001). CONCLUSIONS A simple educational intervention produced a significant reduction in the proportion of inappropriate TIE and increased the proportion of appropriate TIT ordered on an inpatient academic medical service. This study provides a practical approach for using the AUC to reduce the number of inappropriate TIE. Further study in other practice environments is warranted. (J Am Coll Cardiol Img 2013;6:545-55) (C) 2013 by the American College of Cardiology Foundation