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

Abstract

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.

Point-of-care decision support for reducing inappropriate test use: easier said than done

“…In this regard, the results obtained by Boggan et al 6 are fairly representative of similar attempts reported in the literature. Improvement interventions that employ a decision support tool (including simple point-of-care computer reminders as well as more complex decision support) often produce only small improvements.…”

“…The campaign has spread internationally, attesting to the widespread interest in this topic 18. Despite its null results, the study by Boggan et al 6 provides a helpful addition to the overuse literature. Tempting as it is to harness computer order systems to curb inappropriate use with point-of-care decision support, as with other quality problems, the intervention probably needs to be multifaceted, with careful attention to the local drivers of the problem, and a theory for how the proposed intervention addresses them.…”

“…The study by Boggan et al 6 sought to improve the appropriateness of transthoracic echocardiogram (TTE) ordering at a tertiary care Veterans Affairs hospital in the USA by incorporating a decision support tool into an electronic ordering system, focused primarily on congestive heart failure and valvular heart disease, and interestingly including the ordering of a brain natriuretic peptide (BNP) test as part of this tool. However, over the study period, which consisted of a baseline period of 20 months and a post-intervention period of 12 months, the overall number of TTEs ordered did not change significantly.…”

Educational intervention for improving the appropriateness of transthoracic echocardiograms ordered by pediatric cardiologists

“…[6][7][8]15 These studies used a wide variety of EI including passive interventions such as lectures, pocket cards and webinars to the more active ones including an audit and feedback mechanism and point of care decision support tools with varying results. [6][7][8][16][17][18] Chaudhuri et al performed a meta-analysis to assess the effectiveness of various forms of EI to reduce the rate of unnecessary noninvasive cardiovascular imaging based on adult cardiology AUC documents. 19 The study included all forms of noninvasive cardiac imaging including echocardiography, single photon emission computed tomography, myocardial perfusion imaging, cardiac computed tomography angiography and cardiac magnetic resonance imaging.…”

Appropriate Use Criteria for Echocardiography: Evolving Applications in the Era of Value-Based Healthcare

“…A second VA study showed that the effect of a computerized ordering prompt which provides AUC information did not diminish the rate of TTE ordering in a significant manner, signifying there is opportunity to help guide clinicians without curtailing the ability to order studies [19]. Not surprisingly, a small “rebound” effect was noted following the intervention.…”