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Educational Intervention to Reduce Inappropriate Transthoracic Echocardiograms: The Need for Sustained Intervention
Author(s) -
Bhatia Rajan Sacha,
Dudzinski David M.,
Milford Creagh E.,
Picard Michael H.,
Weiner Rory B.
Publication year - 2014
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12505
Subject(s) - intervention (counseling) , medicine , intensive care medicine , physical therapy , nursing
Background We previously demonstrated that an Appropriate Use Criteria ( AUC )‐based educational intervention reduced inappropriate transthoracic echocardiograms ( TTE ) on an inpatient medical service. Whether improved TTE ordering is sustained after discontinuation of the intervention is unknown. Methods We conducted a prospective, time series analysis of an educational intervention designed to reduce inappropriate TTE . Ordering patterns during the intervention were compared with a preintervention control period and a postintervention period. The goal of the present analysis was to determine the TTE ordering patterns after discontinuation of the educational intervention. The primary outcome was the proportion of inappropriate TTE s. Results Using the 2011 AUC 99.2% of all TTE s were classifiable. Compared to the control, there was a 26% reduction in the number of TTE s ordered per day during the intervention (3.9 vs. 2.9 TTE s, P < 0.001), but no significant difference between the intervention and postintervention periods (2.9 vs. 3.1, P = 0.23). The intervention produced a decrease in the inappropriate TTE rate and an increase in the appropriate TTE rate. Compared to the intervention, in the postintervention period the rate of inappropriate TTE s increased (5% vs. 11%, P = 0.01) and appropriate TTE s decreased (93% vs. 86%, P = 0.008). The postintervention rate of inappropriate TTE s was similar to the preintervention control period (11% vs. 13%, P = 0.23). Conclusions Following completion of an AUC ‐based educational intervention the proportion of inappropriate TTE s increased to the preintervention level. The long‐term success of an intervention designed to improve appropriate utilization of TTE requires a sustained effort of education and feedback.