Use and Appropriateness of Transthoracic Echocardiography in an Academic Medical Center: A Pilot Observational Study

Background: Few studies have examined the use of echocardiography in relation to recently released appropriateness criteria for echocardiography. Methods: By using the American College of Cardiology Foundation/American Society of Echocardiography appropriateness criteria, we examined transthoracic echocardiogram (TTE) ordering on the general medicine service at a tertiary referral center. Results: During the 35-day study period, 351 TTE orders in the queue were placed by residents. Of the 274 eligible TTEs, a large majority (86%) were appropriate. The 4 most common indications were heart failure (23%), known or suspected endocarditis (16%), syncope (14%), and arrhythmia (10%). Suspicion of endocarditis was the most common misuse, with 22% of this indication and 13% of the total studied either inappropriate or unclear. Conclusion: Medical house officers at Massachusetts General Hospital are typically using TTE appropriately. Future studies are needed to characterize ordering behavior in various settings and to refine the appropriateness criteria for specific, common indications. (J Am Soc Echocardiogr 2009; 22: 48-52.)