Assessment of inpatient multimodal cardiac imaging appropriateness at large academic medical centers

Cardiovascular Ultrasound

Research

Rory B. Weiner¹  David M. Dudzinski¹  Andrew Remfry²  Howard Abrams³  R. Sacha Bhatia⁴ 

[1] Massachusetts General Hospital, 55 Fruit Sreet, 02114, Boston, MA, USA;University of Toronto Medical School, Medical Sciences Building, 1 King’s College Circle, M5S 1A8, Toronto, Canada;University of Toronto Medical School, Medical Sciences Building, 1 King’s College Circle, M5S 1A8, Toronto, Canada;Peter Munk Cardiac Centre of the University Health Network, Toronto General Hospital, 200 Elizabeth St, M5G 2C4, Toronto, ON, Canada;University of Toronto Medical School, Medical Sciences Building, 1 King’s College Circle, M5S 1A8, Toronto, Canada;Peter Munk Cardiac Centre of the University Health Network, Toronto General Hospital, 200 Elizabeth St, M5G 2C4, Toronto, ON, Canada;Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, 76 Grenville Street, M5S 1B2, Toronto, ON, Canada;Adjunct Scientist, Institute for Clinical Evaluative Sciences, Division of Cardiology, University Health Network and Women’s College Hospital, University of Toronto, 76 Grenville Street, 6th Floor, M5S 1B2, Toronto, ON, Canada;

关键词: Appropriateness use criteria;    transthoracic echocardiogram;    Cardiac catheterization;    transesophageal echocardiogram;    Single-photon emission tomography myocardial perfusion imaging;   

DOI  :  10.1186/s12947-015-0037-0

 received in 2015-08-07, accepted in 2015-10-06,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundResponding to concerns regarding the growth of cardiac testing, the American College of Cardiology Foundation (ACCF) published Appropriate Use Criteria (AUC) for various cardiac imaging modalities. Single modality cardiac imaging appropriateness has been reported but there have been no studies assessing the appropriateness of multiple imaging modalities in an inpatient environment.MethodsA retrospective study of the appropriateness of cardiac tests ordered by the inpatient General Internal Medicine (GIM) and Cardiology services at three Canadian academic hospitals was conducted over two one-month periods. Cardiac tests characterized were transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), single-photon emission tomography myocardial perfusion imaging (SPECT), and diagnostic cardiac catheterization.ResultsOverall, 553 tests were assessed, of which 99.8 % were classifiable by AUC. 91 % of all studies were categorized as appropriate, 4 % may be appropriate and 5 % were rarely appropriate. There were high rates of appropriate use of all modalities by GIM and Cardiology throughout. Significantly more appropriate diagnostic catheterizations were ordered by Cardiology than GIM (93 % vs. 82 %, p = <0.01). Cardiology ordered more appropriate studies overall (94 % vs. 88 %, p = 0.03) but there was no difference in the rate of rarely appropriate studies (3 % vs. 6 %, p = 0.23).ConclusionThe ACCF AUC captured the vast majority of clinical scenarios for multiple cardiac imaging modalities in this multi-centered study on Cardiology and GIM inpatients in the acute care setting. The rate of appropriate ordering was high across all imaging modalities. We recommend further work towards improving appropriate utilization of cardiac imaging resources focus on the out-patient setting.

【 授权许可】

CC BY   
© Remfry et al. 2015