1 / 18

Reduced Inappropriate Echocardiography Requests

Explore the impact of locally agreed guidelines on preoperative echocardiography requests to improve appropriateness, based on a study by Dr. Sheila Carey, Anaesthetic SpR in the Northern Deanery. The study analyzed the reasons for echocardiogram requests, identified inappropriate ones, and suggested guidelines to streamline the process. The findings revealed that a significant number of requests were deemed unacceptable, highlighting the need for consensus among medical staff and the potential benefits of implementing guidelines in reducing unnecessary requests. Limitations of the study included the subjective nature of cardiology reviews and the need for prospective audits to assess the long-term effects of guideline implementation. Recommendations included considering echocardiography only when management would be affected, providing detailed information on request forms, and utilizing local guidelines to optimize resource use.

bernad
Télécharger la présentation

Reduced Inappropriate Echocardiography Requests

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Locally Agreed Guidelines May Reduce Inappropriate Preoperative Echocardiography Requests Dr Sheila Carey Anaesthetic SpR Northern Deanery

  2. Background:Preoperative Echocardiography • Assessment of perioperative cardiac risk is part of anaesthetic preoperative assessment. • Echocardiography can give useful information on cardiac function but has its limitations.

  3. Background:Sunderland Experience • Disquiet from cardiology regarding quality and appropriateness of echo requests. • Uncertainty about indications for pre-operative echo amongst PAAC staff and junior surgical medical staff.

  4. Aims • Audit all preoperative echocardiogram requests • Produce local guidelines • Survey local consultant opinion regarding pre operative echo • Literature review • Evaluate impact of guidelines

  5. Preoperative Echo Survey: Who needs investigating? • New murmur with other indicators of AS • New murmur with no suggestive features of AS • Stable angina • Decompensated heart failure • Known AS. No change in symptoms , no recent echo ( >1 year )

  6. Published Literature / Guidance • ACC/ AHA Guideline • Recommendations for pre-op non-invasive evaluation LV Function • Patients with current or poorly controlled HF* ( Class I) • Patients with prior HF / patients with dyspnoea unknown origin ( Class II) • Valvular heart disease • If a murmur is present, the clinician will need to decide whether or not it represents significant valvular disease • AS poses the greatest risk

  7. Published Literature / Guidance • NCEPOD • 1994/5 • Patient with ESM in association with LVH or myocardial ischaemia should be referred for assessment • 2001 • Patients can be asymptomatic despite mod – severe AS and hence an asymptomatic cardiac murmur should be investigated preoperatively by echocardiography • NCEPOD recognises the spiralling increase in workload this causes but echocardiography services should be accorded an appropriate priority with regards funding

  8. Published Literature / Guidance • Appropriateness Criteria for TTE and TOE (ACCF / ASE / ACEP et al) • Symptoms due to suspected cardiac aetiology (not previously investigated) (9) • Initial investigation of murmur where there is reasonable suspicion of valvular or structural disease (9) • Re-evaluation of a patient with known valvular heart disease with a change in clinical status (9) • Routine ( yearly) evaluation of an asymptomatic patient with severe stenosis (7)

  9. Published Literature / Guidance • Pandit (2004) • Maximising the benefit from pre-operative cardiac evaluation • The uninvestigated murmur • NCEPOD guidelines extremely cautious • Implementation would increase demand greatly on echo services • Local guidelines should be jointly developed

  10. Review of Echocardiogram requests • Preoperative requests collected over a 6 week period. • Reviewed by Consultant Cardiologist to determine appropriateness. • Inappropriate requests – patient note review. • Indications compared against new guidelines

  11. Results • Twenty eight requests for preoperative echocardiography • 7/28 ( 25%) deemed as acceptable by Cardiology • 21 (75%) unacceptable requests • 14 murmurs / added sounds • 4 Left ventricular Function • 3 nature of surgery

  12. Analysis of Unacceptable Requests • 16 Unacceptable requests from Trauma & Orthopaedic Department • 12 sets of notes reviewed • 9 requests could have been prevented (75%) using guidelines

  13. Conclusions 1 • No consensus amongst senior medical staff regarding who requires investigation • Personal preference probably dictates choice except when clear cut suspicion of AS • Advice given to other staff, (e.g. trainees, PAAC nurses) likely to be inconsistent • Guidelines may improved this

  14. Sunderland echocardiogram request

  15. Conclusions 2 • A significant proportion preoperative echocardiogram requests are unacceptable • Retrospective application of guidelines suggests inappropriate requests could be reduced • Potential for a rise in number of requests if patients selected more appropriately

  16. Limitations • Cardiology review subjective • Retrospective analysis • Prospective Audit needed to clarify the effect of introducing guidelines

  17. Recommendations • Investigation should only be considered if management will be affected • Information given on request form has to be relevant and detailed • Local guidelines can help direct appropriate use of resources

More Related