Journal of the American Society of Echocardiography
Clinical Utility of Guideline-Based Echocardiography: A Prospective Study of Outpatient Referral Patterns at a Tertiary Care Center
Section snippets
Echocardiographic Examination and Study Protocol
The study was performed at the Centro Cardiologico Monzino, IRCCS, a teaching hospital in the Milan area of Northern Italy. Outpatient echocardiography for adults is performed by cardiologists on rotation in 2 laboratories, each with 2 (morning and afternoon) work shifts. We prospectively analyzed 520 outpatient echocardiograms scanned consecutively by a single cardiologist during a 7-month period (January to July 2004), evenly distributed over the working week, who used a Philips Sonos 2000
Indications for Requesting Echocardiograms, Diagnosis, and Demographics
Of the 520 echocardiograms analyzed (male patients, 53.7%; female patients, 46.3%; P = not significant [NS]), 148 were first examinations and 372 were follow-up studies (28.5% vs 71.5%, P < .001). Urgent examinations were in a minority (5.2%) and were not analyzed separately. Indications were undetermined in 20 patients (3.8%). When hospital specialists were compared with family physicians, the majority of requests originated from the former (374, 72% vs 146, 28%: P < .001) (Table 1), and this
Discussion
Our prospective study is the first to analyze echocardiography requesting patterns for outpatients at a tertiary referral center. It found a rather low, generally 50%, adherence of indications to guidelines and a 60% utility of the examination, after referral by either family physicians or hospital specialists, but with differences between cardiovascular subspecialists. Adherence of indications to guidelines was significantly associated with the clinical utility of the examination.
Study Limitations
A diagnostic test may have an incremental value with respect to the information known about the patient. Some of this information may have not been disclosed to the patient by the physician ordering the examination, included on the request form, or apparent from the medical documentation available to researchers. This may have led to underestimation of both adherence to indication guidelines and the clinical utility of the echocardiogram. Further, the evaluation of the clinical utility of an
Conclusions
Our results suggest that, within the NHS, the increasing referrals to specialists do not reduce unnecessary echocardiograms because adherence of indications to guidelines and clinical utility of the examinations were similar between specialists and family physicians. Patient waiting lists and health care costs may be favorably influenced by implementing policies aimed at increasing knowledge and application of existing indication guidelines. By reducing unnecessary examinations, these policies
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