Open Access

ARTICLE

Appropriateness of pediatric outpatient transthoracic echocardiogram orders following cessation of an active educational intervention

Shae Anderson^1,2, Courtney E. McCracken², Ritu Sachdeva^1,2

1 Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
2 Children’s Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, Georgia

* Corresponding Author: Shae Anderson, Department of Pediatrics, Emory University School of Medicine, 1405 Clifton Road, Atlanta GA 30322. Email:

Congenital Heart Disease 2018, 13(6), 1050-1057. https://doi.org/10.1111/chd.12679

Abstract

Objective: The educational intervention (EI) through the Pediatric Appropriate Use of Echocardiography (PAUSE) multicenter study resulted in improved appropriate‐ ness of transthoracic echocardiogram (TTE) orders at our center. The current study evaluated if this pattern persisted after cessation of EI and the potential physician characteristics influencing appropriateness.
Design: Outpatients (≤18 years old) seen for initial evaluation during the EI (July to October, 2015) and 6‐month post‐EI (May to August, 2016) phases were included. Comparison was made between TTE rates and appropriateness ratings during EI and post‐EI phase. Association between TTE rate and appropriateness with physician characteristics (age, experience, patient volume, and area of practice) was deter‐ mined using odds ratio.
Results: The study included 7781 patients (EI: N = 4016; post‐EI: N = 3765) seen by 31 physicians. Comparison of appropriateness ratings in a randomized sample (EI: N = 1270; post‐EI: N = 1325 patients) showed no significant differences between the two phases (appropriate: 75.2% vs 74.9%, P = .960; rarely appropriate 4.1% vs 6.5%, P = .065). Though there was significant variability among physicians for TTE order appropriateness (P = .044) and ordering rate (P < .001), none of their characteristics were associated with appropriateness and only a higher patient volume was associ‐ ated with decreased odds of TTE ordering (OR = 0.7).
Conclusion: The PAUSE study EI resulted in maintaining appropriate utilization of TTEs at our center for 6 months following its cessation. Though not statistically sig‐ nificant, there was a trend toward increase in the proportion of studies for indica‐ tions designated rarely appropriate (R). There was significant physician variability in TTE ordering and appropriateness during both phases. Development of EI to reduce physician variability and integration of EI with provider workflow may help sustain appropriate TTE utilization.

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