From the 2022 HVPA National Conference
Becca Engels MD, MPH (Johns Hopkins Hospital), Stacie Richardson, Ken Lee, Allison Hays MD, Sara Keller MD, Amit Pahwa MD
Over the past two decades, Transthoracic echocardiogram (TTE) orders increased at a rate of about 5-8% per year, and 25% of these orders are composed of repeat TTE’s. However, only a third of repeat orders are considered clinically appropriate. Our study leveraged the electronic medical record (EMR) to reduce repeat TTEs. We created a best practice alert (BPA) within the EMR throughout the Johns Hopkins Health System (JHHS). The BPA alerts when a clinician orders a TTE on a hospitalized patient who already had one in the system within the prior 3 months. The BPA displays the findings from the most recent TTE and asks the clinician if they would like to continue with the order or cancel it. If a provider continues with the order, a free text reason must be entered to explain the rationale for continuing with the order. Since initiation of the BPA, 34.3% of clinicians opted to discontinue the order, and 65.7% chose to continue. Readmission rates and length of stay (LOS) served as balancing measures. Patients who underwent repeat TTE testing had a 20% 30-day readmission rate as compared to 19% readmission rate in those who did not have repeat testing (p-value 0.88). The average LOS for patients who underwent repeat TTE was 11.4 days vs. an average LOS of 9.3 days for patients who did not undergo repeat TTE (p-value 0.41). The BPA designed within the EMR successfully reduced repeat TTEs without leading to increased readmissions or LOS.