Journal of the American Society of Echocardiography
Clinical InvestigationsEnhancing Quality In Pediatric EchocardiographyImplementation of Appropriate Use Criteria for Transthoracic Echocardiography in Follow-Up Care of Pediatric Patients with Congenital Heart Disease
Section snippets
Methods
The study was approved by the institutional review board at Children's Healthcare of Atlanta. Indications for TTE from the 2020 CHD AUC document were incorporated into the EMR ordering system (EPIC) in May 2020 to promote the use of AUC in routine clinical work flow. Physicians in our clinics provide specific AUC indications to sonographers after they have seen patients, and then the sonographers enter the indications into the EMR. Physicians use laminated cards for the 19 color-coded tables in
Results
During the study period, a total of 5,158 transthoracic echocardiographic examinations were ordered by 44 clinicians (41 physicians and three nurse practitioners) for follow-up care in our clinics in patients <18 years of age. Of the 5,158 studies, 3,979 were for CHD indications included in the 2020 CHD AUC document, 37 were for CHD lesions not included in the document, and 1,142 were for non-CHD indications (Table 1). Of the 3,979 indications for CHD, 88% were for indications rated A, 2% for
Discussion
To our knowledge, this is the first study analyzing the appropriateness of TTE in follow-up care of pediatric patients with CHD on the basis of the 2020 CHD AUC document. Using this document, we were able to successfully stratify the majority of transthoracic echocardiographic studies for follow-up of CHD, and the vast majority of studies were for indications rated A. The study also provides a broad perspective on the utilization of TTE for follow-up care in pediatric patients and shows that
Conclusion
Our study shows that majority of transthoracic echocardiographic examinations performed for follow-up care of CHD were for indications rated A on the basis of the 2020 AUC document. Although 75% of studies performed for follow-up care in our clinics were for patients with CHD, the other 25% were for non-CHD indications. Simple CHDs were associated with higher use of indications rated M or R, and a large proportion of those rated R were misclassified. Although further education to improve
Acknowledgment
We thank Ms. Deborah Whitaker (Sibley Heart Center) for her help in extracting the data for this study.
References (17)
- et al.
ACC/AAP/AHA/ASE/HRS/SCAI/SCCT/SCMR/SOPE 2014 appropriate use criteria for initial transthoracic echocardiography in outpatient pediatric cardiology: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Academy of Pediatrics, American Heart Association, American Society of Echocardiography, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography
J Am Coll Cardiol
(2014) - et al.
Improvement in appropriateness of pediatric outpatient echocardiography orders following integration of the appropriate use criteria within the electronic medical record ordering system
J Am Soc Echocardiogr
(2020) - et al.
Pediatric appropriate use criteria implementation project: a multicenter outpatient echocardiography quality initiative
J Am Coll Cardiol
(2015) - et al.
Factors influencing pediatric outpatient transthoracic echocardiography utilization before appropriate use criteria release: a multicenter study
J Am Soc Echocardiogr
(2017) - et al.
Effect of release of the first pediatric appropriate use criteria on transthoracic echocardiogram ordering practice
Am J Cardiol
(2016) - et al.
Multimodality imaging guidelines for patients with repaired tetralogy of Fallot: a report from the American Society of Echocardiography: developed in collaboration with the Society for Cardiovascular Magnetic Resonance and the Society for Pediatric Radiology
J Am Soc Echocardiogr
(2014) - et al.
Multimodality imaging guidelines of patients with transposition of the great arteries: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography
J Am Soc Echocardiogr
(2016) - et al.
Multimodality imaging in individuals with anomalous coronary arteries
JACC Cardiovasc Imaging
(2017)
Cited by (0)
Conflicts of Interest: None.