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"Echo pause" for postoperative transthoracic echocardiographic surveillance.

Authors
  • Cox, Kelly1
  • Arunamata, Alisa1
  • Krawczeski, Catherine D1
  • Reddy, Charitha1
  • Kipps, Alaina K1
  • Long, Jin2
  • Roth, Stephen J1
  • Axelrod, David M1
  • Hanley, Frank3
  • Shin, Andrew1
  • Selamet Tierney, Elif Seda1
  • 1 Department of Pediatrics, Division of Pediatric Cardiology, School of Medicine, Stanford University, Palo Alto, California.
  • 2 Department of Medicine, School of Medicine, Stanford University, Stanford, California.
  • 3 Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Palo Alto, California.
Type
Published Article
Journal
Echocardiography (Mount Kisco, N.Y.)
Publication Date
Nov 01, 2019
Volume
36
Issue
11
Pages
2078–2085
Identifiers
DOI: 10.1111/echo.14505
PMID: 31628768
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

No guidelines exist for inpatient postoperative transthoracic echocardiographic (TTE) surveillance in congenital heart disease. We prospectively evaluated indications for postoperative TTEs in patients with congenital heart disease to identify areas to improve upon (Phase 1) and then assessed the impact of a simple pilot intervention (Phase 2). We included patients with RACHS-1 (Risk Adjustment for Congenital Heart Surgery) scores of 2 and 3 to keep the cohort homogenous. During Phase 1, we collected data prospectively to identify postoperative TTEs for which there were no new findings and no associated clinical management decisions ("potentially redundant" TTEs). During Phase 2, prior to placement of a TTE order, an "Echo Pause" was performed during rounds to prompt review of prior TTE results and indication for the current order. The number of "potentially redundant" TTEs during Phase 1 vs. Phase 2 was compared. During Phase 1, 98 postoperative TTEs were performed on 51 patients. Potentially "redundant" TTEs were identified in two main areas: (a) TTEs ordered to evaluate pericardial effusion and (b) TTEs ordered with the indication of "postoperative," "follow-up," or "discharge" in the setting of a prior complete postoperative TTE and no apparent change in clinical status. During Phase 2, 101 TTEs were performed on 63 patients. The number of "potentially redundant" TTEs decreased from 14/98 (14%) to 5/101 (5%) (P = .026). Our results suggest that the number of "potentially redundant" TTEs during inpatient postoperative surveillance of patients with congenital heart disease can be decreased by a simple intervention during rounds such as an "Echo Pause." © 2019 Wiley Periodicals, Inc.

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