Journal Article

158 Common reasons of rejected transthoracic echocardiogram requests in a tertiary referral hospital

Brown, Pamela, Dundas, James, Cheng, Shue Jun, Lim, See Wei, Middleton, Samantha

2022

Overview

IntroductionTransthoracic echocardiogram (TTE) is routinely requested in the clinical setting as it is a non-invasive investigation that provides invaluable diagnostic information. However, inappropriate requests impact the quality of service provision to other patients in a timely and effective manner. Rejected TTE (rTTE) requests were evaluated over two months to determine common themes of inappropriate referrals in a tertiary unit.MethodsThe study design utilised both retrospective and prospective methods to analyse rTTE requests from September to October 2021. A collaboration with the local echocardiography unit identified rTTE requests within the aforementioned time frame. A retrospective cohort study was performed in the first month to evaluate the underlying reason of rTTE requests. This was accomplished by entering patient unique identifiable number on the electronic request system to obtain the data. On 01/10/2021, a trust-wide oral presentation aimed at medical practitioners was organised to facilitate the understanding of TTE indications and contraindications in accordance with British Society of Echocardiography (BSE) guidelines. Subsequently, a prospective cohort study observed a similar technique to generate reproducible data in the later half of the study duration. After compiling all anonymous data on a table, this information was translated into pie charts.ResultsA total of 329 rTTE requests were identified in the study. Duplicated requests and lack of indications contributed predominantly to the number of recognised cases, at 115 (34.95%) and 98 (29.79%) cases respectively. Other significant reasons including recent TTE performed (n=31; 9.42%), cancellation by clinician (n=28; 8.51%) and patient death (n=24; 7.29%) also led to similar outcomes. Additionally, trivial reasons formed less than five percent of cases each (table 1). Out of 98 (29.79%) cases as above, cardiac-suspected morbidities or symptoms prompted TTE requests – infective endocarditis (n=39; 39.80%), left or right ventricular failure (n=25; 25.51%) and syncope/arrhythmia (n=19; 19:39%) in that order – but insufficient clinical information entered saw these requests being rejected. The common reasons of rejection in these circumstances were no indications as per modified Duke criteria, normal B-natriuretic peptide (BNP) level and lack of clinical symptoms as per BSE guidelines respectively. Promoting the understanding of TTE indications and contraindications appeared to reduce the number of rTTE requests especially in the domains of duplicated requests and lack of indications, which observed a decrement of 11 (3.3%) and 14 (4%) cases respectively.Abstract 158 Figure 1Reasons of rejected transthoracic echocardiogram requests in September and October 2021Abstract 158 Figure 2Insufficient indication subclassificationConclusionsPromoting the understanding of TTE indications and contraindications amongst clinicians led to reduction of inappropriate referrals. This suggests the overall benefit may be enhanced by implementing a series of questions prior to electronic request submission.Conflict of InterestNone to declare

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group LTD
• Subject: Contraindications / Imaging / inappropriate requests / resource utilisation / transthoracic echocardiogram / Ultrasonic imaging