Abstract 9362: A Quality Improvement Project to Optimize TEE Orders and Reduce Hospitalization Cost at a Large Volume Academic Hospital

Abstract

Introduction: Appropriate use criteria (AUC) for indication of transesophageal echocardiography (TEE) were revised in 2011. Aim: To evaluate the appropriateness of TEEs ordered at Ochsner LSU Health Shreveport based on 2011 AUC guidelines and take necessary steps to optimize the TEE workflow and reduce hospitalization cost. Method: A retrospective analysis of the TEE case requests received by the echocardiography lab at Ochsner LSU Health Shreveport between March 1, 2020 and August 31, 2020 was carried out. Each TEE case request was classified as appropriate (A), inappropriate (I) or uncertain (U) based on the 2011 AUC guideline. TEE case requests were divided based on the ordering specialty as well as indications. Result: Among the total 372 case requests for TEE,189 (50.80%) were ordered by cardiologists and 183 (49.20%) were ordered by non-cardiologists. Out of the 189 orders by cardiologists, 184 (97.35%) were appropriate and 5 (2.65%) were inappropriate. Cardiologists ordered 123 TEEs for Atrial fibrillation/flutter evaluation/management, 33 for valvular evaluation, 10 for evaluation of mass/vegetation, 3 for atrial mass evaluation, 10 for CVA workup and 10 for other reasons. Among the total 183 TEE orders placed by non-cardiologists, 125 (68.31%) were appropriate and 58 (31.69%) were inappropriate. Specialty-wise, Neurology placed 78 TEE orders (54-A, 24-I), Hospital Medicine placed 59 orders (38-A, 21-I) while other specialties placed 46 orders (33-A, 13-I). Most common indications for TEE requests by non-cardiologists were for CVA workup (62-A, 30-I) and infective endocarditis workup (21-A, 13-I). Conclusion: 83% of all the TEE orders (309 out of 372) were appropriate. 97% (184 from 189) of the TEE orders by cardiologists were appropriate compared to 68% (125 from 183) orders by non-cardiologists. Following this result, medical providers were educated about the correct indications of TEE by educational presentation as well as distributing posters and pocket cards. Plan is to also evaluate the appropriateness of TEE orders post intervention phase. We believe that educating the physician providers can optimize the appropriate TEE requests, avoid unnecessary invasive procedures and reduce the hospitalization cost.