The application of appropriate use criteria for transthoracic echocardiography in a cardiac intensive care unit

Salik, Jonathan R; Sen, Sounok; Picard, Michael H.; Weiner, Rory B.; Dudzinski, David M.

doi:10.1111/echo.14314

Cited by 6 publications

(4 citation statements)

References 23 publications

(89 reference statements)

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“…The study reported that although 9 in 10 TTEs were appropriate by AUC, less than 1 in 3 TTEs actually resulted in an active change in patient care, with nearly half resulting in the continuation of the current clinical care plan[ 10 ]. Other studies[ 5 - 8 ] have shown similar results and this leads to the revelation that while AUC may be useful to guide the choice to pursue a TTE, physician perception of the possibility of the presence of indications supported by the AUC may not necessarily correlate to the change in management expected and therefore still lead to overutilization of TTE due to the various reasons that make TTE so easy to order.…”

Section: Discussionmentioning

confidence: 74%

“…The rapid increase of TTE utilization brings the question of whether TTE is being overused or possibly being applied in inappropriate situations. Multiple published reports have suggested that echocardiograms may be performed with decreased clinical utility and may not have a clinical effect on the management of a patient[ 5 - 8 ]. We sought to evaluate the TTE-ordering physician’s perceived impact echocardiography has on patient management.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic and treatment utility of echocardiography in the management of the cardiac patient

Khalili¹,

Drummond

Ramjattan

et al. 2020

WJC

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BACKGROUND Echocardiograms are an incredibly useful diagnostic tool due to their lack of harmful radiation, the relative ease and speed with which they can be performed, and their almost ubiquitous availability. Unfortunately, the advantages that support the use of echocardiography can also lead to the overuse of this technology. We sought to evaluate the physician perceived impact echocardiography has on patient management. AIM To evaluate the physician perceived impact echocardiography has on patient management. METHODS Surveys were distributed to the ordering physician for echocardiograms performed at our institution over a 10-wk period. Only transthoracic echocardiograms performed on the inpatient service were included. Surveys were distributed to either the attending physician or the resident physician listed on the echocardiogram order. The information requested in the survey focused on the indication for the study and the perceived importance and effect of the study. Observational statistical analysis was performed on all of the answers from the collected surveys. RESULTS A total of 103 surveys were obtained and analyzed. The internal medicine (57%) and cardiology (37%) specialties ordered the most echocardiograms. The most common reason for ordering an echocardiogram was to rule out a diagnosis (38.2%). Only 27.5% of physicians reported that the echocardiogram significantly affected patient care, with 18.6% reporting a moderate effect, and 30.4% reporting a mild effect. A total of 19.6% of physicians stated that there was no effect on patient management. Additionally, 43.1% of physicians reported that they made changes in patient management due to no change having occurred in the disease, 11.8% reported that changes in management were based on the recommendation of a specialist, and only 9.8% reported that further imaging was ordered due to the results of the echocardiogram. The majority of physicians (67.6%) considered an echocardiogram to be “somewhat essential” in the management of adult inpatients, with only 15.7% considering it “essential”. CONCLUSION The majority of physicians surveyed report the echocardiogram had only a mild effect on management with only 27.5% reporting a significant effect. However, the majority of physicians (83.3%) perceived an echocardiogram to be somewhat or entirely essential for management. Only 9.8% reported the echo led to further imaging. These insights into ordering physician reasoning should help guide better definition of the optimal and ideal use of echocardiography.

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Section: Discussionmentioning

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Diagnostic and treatment utility of echocardiography in the management of the cardiac patient

Khalili¹,

Drummond

Ramjattan

et al. 2020

WJC

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“…16 The Appropriateness Method has been used to develop appropriate use criteria internationally and across health disciplines, 17e19 with a number of apropirate use criteria implemented in clinical practice, including for advanced diagnostic imaging 20 and transthoracic echocardiography. 21 The RAND/UCLA Appropriateness Method involves sequential phases, detailed in Fig. 1.…”

Section: Designmentioning

confidence: 99%

Appropriate use criteria for endotracheal suction interventions in mechanically ventilated children: The RAND/UCLA development process

Schultz¹,

Charles²,

Long³

et al. 2022

Australian Critical Care

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Objectives: Endotracheal suction is an invasive airway clearance technique used in mechanically ventilated children. This article outlines the methods used to develop appropriate use criteria for endotracheal suction interventions in mechanically ventilated paediatric patients. Methods: The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop paediatric appropriate use criteria. This included the following sequential phases of defining scope and key terms, a literature review and synthesis, expert multidisciplinary panel selection, case scenario development, and appropriateness ratings by an interdisciplinary expert panel over two rounds. The panel comprised experts in the fields of paediatric and neonatal intensive care, respiratory medicine, infectious diseases, critical care nursing, implementation science, retrieval medicine, and education. Case scenarios were developed iteratively by interdisciplinary experts and derived from common applications or anticipated intervention uses, as well as from current clinical practice guidelines and results of studies examining interventions efficacy and safety. Scenarios were rated on a scale of 1 (harm outweighs benefit) to 9 (benefit outweighs harm), to define appropriate use (median: 7 to 9), uncertain use (median: 4 to 6), and inappropriate use (median: 1 to 3) of endotracheal suction interventions. Scenarios were than classified as a level of appropriateness. Conclusions: The RAND Corporation/University of California, Los Angeles Appropriateness Method provides a thorough and transparent method to inform development of the first appropriate use criteria for endotracheal suction interventions in paediatric patients.

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“…Evaluation of ventricular function following an acute coronary syndrome or in the case of hypotension of unknown or suspected cardiac aetiology (2), identifying the mechanisms of circulatory failure (3), tailoring and titrating pharmacologic or mechanical circulatory support (4), are among the most frequent indications to perform CCE. When integrated with lung ultrasound, this becomes a powerful bedside tool to allow optimization and weaning of these therapies (5).…”

Section: Introductionmentioning

confidence: 99%

Echocardiography in the intensive care unit: an essential tool for diagnosis, monitoring and guiding clinical decision-making

Soliman-Aboumarie

Pastore

Galiatsou

et al. 2021

Imaging

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In the last years, new trends on patient diagnosis for admission in cardiac intensive care unit (CICU) have been observed, shifting from acute myocardial infarction or acute heart failure to non-cardiac diseases such as sepsis, acute respiratory failure or acute kidney injury. Moreover, thanks to the advances in scientific knowledge and higher availability, there has been increasing use of positive pressure mechanical ventilation which has its implications on the heart. Therefore, there is a growing need for Cardiac intensivists to quickly, noninvasively and repeatedly evaluate various hemodynamic conditions and the response to therapy.Transthoracic critical care echocardiography (CCE) currently represents an essential tool in CICU, as it is used to evaluate biventricular function and complications following acute coronary syndromes, identify the mechanisms of circulatory failure, acute valvular pathologies, tailoring and titrating intravenous treatment or mechanical circulatory support. This could be completed with trans-oesophageal echocardiography (TOE), advanced echocardiography and lung ultrasound to provide a thorough evaluation and monitoring of CICU patients. However, CCE could sometimes be challenging as the acquisition of good-quality images is limited by mechanical ventilation, suboptimal patient position or recent surgery with drains on the chest. Moreover, there are some technical caveats that one should bear in mind while performing CCE in order to optimize its use and avoid misleading findings. The aim of this review is to highlight the key role of CCE, providing an updated overview of its main applications and possible pitfalls in order to facilitate its use in CICU for clinical decision-making.

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The application of appropriate use criteria for transthoracic echocardiography in a cardiac intensive care unit

Cited by 6 publications

References 23 publications

Diagnostic and treatment utility of echocardiography in the management of the cardiac patient

Diagnostic and treatment utility of echocardiography in the management of the cardiac patient

Appropriate use criteria for endotracheal suction interventions in mechanically ventilated children: The RAND/UCLA development process

Echocardiography in the intensive care unit: an essential tool for diagnosis, monitoring and guiding clinical decision-making

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