Recurrent Cardiology Evaluation for Innocent Heart Murmur: Echocardiogram Utilization

Dalal, Nupur; Dzelebdzic, Sanja; Frank, Lowell H.; Clauss, Sarah; Mitchell, Stephanie; Aljohani, Othman A.; Bradley-Hewitt, Tyler; Harahsheh, Ashraf S.

doi:10.1177/0009922818787280

Cited by 9 publications

(8 citation statements)

References 15 publications

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“…in the year 2014 which clearly notes transthoracic echocardiogram for presumed innocent heart murmur as “rarely appropriate” indication [18]. Despite published guidelines, there is a significant utilization of transthoracic echocardiography as well as recurrent cardiology visits for innocent heart murmur [13-14]. Giuffre et al and Bardsen et al looked at parental anxiety after a diagnosis of childhood heart murmur [15,17].…”

Section: Reviewmentioning

confidence: 99%

Innocent Heart Murmur

Doshi¹

2018

Cureus

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Heart murmur is the most common reason for a referral to a pediatric cardiologist. Virtually all children have a heart murmur during their childhood. Less than 1% of murmurs are pathological in children. Innocent/functional heart murmur is the most common type of heart murmur. There are multiple theories proposed to identify etiology of innocent heart murmur with varying consensus, but everybody agrees that innocent heart murmur does not carry any morbidity or mortality risk. Even today, heart murmur is associated with high physician uncertainty and parental anxiety. Extensive cardiac evaluation for such a benign finding is also associated with high health care utilization and cost. This article attempts to review this long-known finding which continues to remain a diagnostic challenge.

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Section: Reviewmentioning

confidence: 99%

Innocent Heart Murmur

Doshi¹

2018

Cureus

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“…In the SCAMPs ® chest pain cohort, an echocardiogram was obtained by a cardiologist in 23.4% of patients despite not meeting the medical red-flag criteria. 4 In children who presented for a second cardiology visit with innocent heart murmur, Dalal et al 25 demonstrated that echocardiograms were obtained in 36% of all follow-up visits. In all but one, the indication for the echocardiogram was deemed as rarely appropriate.…”

Section: Discussionmentioning

confidence: 99%

Promoting Judicious Primary Care Referral of Patients with Chest Pain to Cardiology: A Quality Improvement Initiative

et al. 2021

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Objective To decrease referrals to cardiology of patients ages 7 to 21 years with low-probability cardiac pathology who presented to primary care with chest pain by 50% within 24 months. Study Design A multidisciplinary team designed and implemented an initiative consisting of 1) a decision support tool (DST), 2) educational sessions, 3) routine feedback to improve use of referral criteria, and 4) patient family education. Four pediatric practices, comprising 34 pediatricians and 7 nurse practitioners, were included in this study. We tracked progress via statistical process control charts. Results A total of 421 patients ages 7 to 21 years presented with chest pain to their pediatrician. The utilization of the DST increased from baseline of 16% to 68%. Concurrently, the percentage of low-probability cardiology referrals in pediatric patients ages 7 to 21 years who presented with chest pain decreased from 17% to 5% after our interventions. At a median follow-up time of 0.9 years (interquartile range, 0.3–1.6 years), no patient had a life-threatening cardiac event. Conclusion Our health care improvement initiative to reduce low-probability cardiology referrals for children presenting to primary care practices with chest pain was feasible, effective, and safe.

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“…The ACCU consists of 26 private and shared beds located within a free-standing quaternary Children’s Hospital in Washington, DC. 4 , 5 The ACCU is not a closed cardiac unit, though cardiology patients and cardiac surgery patients are solely admitted to the unit. Nephrology patients are preferentially admitted to the ACCU, and other services could be admitted during high census times when their traditional units are full.…”

Section: Methodsmentioning

confidence: 99%

“…A centerline shift was determined based on 8 or more datapoints above or below the centerline. 4 , 5 …”

Section: Methodsmentioning

confidence: 99%

Quality Improvement Initiative Increasing Early Discharges From an Acute Care Cardiology Unit for Cardiac Surgery and Cardiology Patients–Associated With Reduced Hospital Length of Stay

Colyer

Ring

Gallagher

et al. 2022

Pediatric Quality &Amp; Safety

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Introduction: Discharging patients from the acute care setting is complex and requires orchestration of many clinical and technical processes. Focusing on timely discharges improves throughput by off-loading ICUs and coordinating safe outpatient transitions. Our data review demonstrated most discharges occurred later in the day. We sought to improve our discharge times for cardiology and cardiovascular surgery (CVS) patients in our 26-bed inpatient acute care cardiology unit (ACCU). We aimed to increase the number of discharges between 6 am and 12 pm for cardiology and CVS patients on ACCU from 5 to 10 patients per month over 6 months and sustain. Methods: We performed a simplified Failure Mode Effect Analysis on the discharge process and identified improvement opportunities. Our key drivers centered around education, documentation, and planning. Our interventions included: staff education, communication of discharge expectations, daily quality board rounds, hospital-wide collaboration emphasizing conditional discharges, and hospital information technology (IT) improvements. We utilized statistical process control charts to analyze the data. Results: Discharges between 6 am, and 12 pm increased from a baseline of 5 (8%) to 12 (18%) patients per month with a centerline shift. Our process measures demonstrated appropriate conditional discharge usage linked to earlier discharges. Upgrades to our EMR, documentation further increased our timely discharges. Our efforts resulted in a 22% reduction in hospital length of stay from 11.2 to 8.7 days without increased readmission rates suggesting that improved efficiency did not impact care quality. Conclusion: We successfully show how multidisciplinary collaboration and systems-based improvement can increase the number of safe, early discharges.

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Recurrent Cardiology Evaluation for Innocent Heart Murmur: Echocardiogram Utilization

Cited by 9 publications

References 15 publications

Innocent Heart Murmur

Innocent Heart Murmur

Promoting Judicious Primary Care Referral of Patients with Chest Pain to Cardiology: A Quality Improvement Initiative

Quality Improvement Initiative Increasing Early Discharges From an Acute Care Cardiology Unit for Cardiac Surgery and Cardiology Patients–Associated With Reduced Hospital Length of Stay

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