Demands on echocardiography services are increasing annually. This Quality Improvement Project aimed to see whether a point of care screening echocardiography (SE) service in the acute inpatient medical setting might help reduce demand on full trans-thoracic echocardiography services (FE). The indication and results of all FE requests on the admission ward were analysed over a three-month period. Following this, it was considered whether a theoretical SE occurring prior, would have changed the on-going utilisation of FE resources. Of the 67 requests analysed, 57 underwent FE. 25% revealed no abnormality. In 47%, a SE prior may have changed the future use of FE resources. This small retrospective review highlights the potential benefits of a SE service and further work is required.

[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]

References

1. NHS England. NHS Diagnostic Waiting Times and Activity Data (2017). Available from: https://www.england.nhs.uk/statistics/wpcontent/uploads/sites/2/2016/06/DWTA-Report-January-2017.pdf
2. British Society of Echocardiography. Cardiac Physiology Workforce Options Analysis (2016). Available from: https://www.bsecho.org/cardiac-physiology-workforce-options-analysis/.
3. British Society of Echocardiography. BSE Level 1 Minimum Dataset. https://www.bsecho.org/media/236270/level_1_minimum_dataset_v2.pdf.
4. Moore CL, Rose GA, Tayal VS, et al. Determination of Left Ventricular Function by Emergency Physician Echocardiography of Hypotensive Patients. Acad Emerg Med 2002; 9: 186–93.
5. Randazzo MR, Snoey ER, Levitt MA, et al. Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography. Acad Emerg Med Off J Soc Acad Emerg Med 2003; 10: 973–7.
6. See KC, Ong V, Ng J, et al. Basic critical care echocardiography by pulmonary fellows: learning trajectory and prognostic impact using a minimally resourced training model. Crit Care Med 2014;42: 2169–77.
7. Razi R, Estrada JR, Doll J, et al. Bedside hand-carried ultrasound by internal medicine residents versus traditional clinical assessment for the identification of systolic dysfunction in patients admitted with decompensated heart failure. J Am Soc Echocardiogr 2011; 24:1319–24.
8. Adhikari S, Fiorello A, Stolz L, et al. Ability of emergency physicians with advanced echocardiographic experience at a single center to identify complex echocardiographic abnormalities. Am J Emerg Med 2014; 32: 363–6.
9. Bustam A, Azhar MN, Veriah RS, et al. Performance of emergency physicians in point-of-care echocardiography following limited training. Emerg Med J 2014; 31: 369–73.
10. Johnson BK, Tierney DM, Rosborough TK, et al. Internal medicine point-of-care ultrasound assessment of left ventricular function correlates with formal echocardiography. J Clin Ultrasound 2016; 44: 92–9.
11. Alexander JH, Peterson ED, Chen AY, et al. Feasibility of pointof-care echocardiography by internal medicine house staff. Am Heart J 2004; 147: 476–81.
12. Yim ES, Basilico F, Corrado G. Early screening for cardiovascular abnormalities with preparticipation echocardiography: utility of focused physician-operated echocardiography in preparticipation screening of athletes. J Ultrasound Med 2014; 33: 307–13.
13. Yim ES, Gillis EF, Ojala K, et al. Focused transthoracic echocardiography by sports medicine physicians: measurements relevant to hypertrophic cardiomyopathy. J Ultrasound Med 2013;32: 333–8.
14. Ploutz M, Lu JC, Scheel J, et al. Handheld echocardiographic screening for rheumatic heart disease by non-experts. Heart 2016;102: 35–9.
15. NHS Improvement. Admitted Care & Outpatient Procedure Prices 2018/9 (2018). Available from: https://improvement.nhs.uk/resources/national-tariff-1719/#h2-tariff-documents.
16. Garg S, Saha A, Clark A. Is sensible use being made of an inpatient Holter monitoring and transthoracic echocardiogram service within acute medicine? Clin Med 2006; 6: 586–91.
17. Fedson S, Neithardt G, Thomas P, et al. Unsuspected clinically important findings detected with a small portable ultrasound device in patients admitted to a general medicine service. J Am Soc Echocardiogr 2003; 16: 901–5.
18. Nedeljković-Arsenović O, Vujisić-Tešić B, NinkovićMrđenovački O, et al. Unexpected echocardiographic findings in one vessel coronary artery disease. Cor Vasa 2017; 59: e515–9.
19. Kirkpatrick JN, Ky B, Rahmouni HW, et al. Application of Appropriateness Criteria in Outpatient Transthoracic Echocardiography. J Am Soc Echocardiogr 2009; 22: 53–9.
20. Yates J, Royse CF, Royse C, et al. Focused cardiac ultrasound is feasible in the general practice setting and alters diagnosis and management of cardiac disease. Echo Res Pract 2016; 3: 63–9.
21. Hall DP, Jordan H, Alam S, et al. The impact of focused echocardiography using the Focused Intensive Care Echo protocol on the management of critically ill patients, and comparison with full echocardiographic studies by BSE-accredited sonographers. J Intensive Care Soc 2017; 18: 206–11.
22. Jellis CL, Griffin BP. Are We Doing Too Many Inpatient Echocardiograms?: The Answer From Big Data May Surprise You! J Am Coll Cardiol 2016; 67: 512–4.
23. Yamamoto R, Clanton D, Willis RE, et al. Rapid decay of transthoracic echocardiography skills at 1 month: A prospective observational study. J Surg Educ 2018; 75: 503–9.
24. British Society of Echocardiography. Reaccreditation Guideline and application form. Available from: https://www.bsecho.org/accreditation/re-accreditation-process/.
25. British Cardiovascular Society Working Group. Out-Of-Hours Cardiovascular Care: Management of Cardiac Emergencies and Hospital Inpatients (2016). Available from: http://www.bcs.com/documents/BCSOOHWP_Final_Report_05092016.pdf.
26. Ma IWY, Arishenkoff S, Wiseman J, et al. Internal Medicine Pointof-Care Ultrasound Curriculum: Consensus Recommendations from the Canadian Internal Medicine Ultrasound (CIMUS) Group. J Gen Intern Med 2017; 32: 1052–7.
27. Blans MJ, Bosch FH. Ultrasound in acute internal medicine; time to set a European standard. Eur J Intern Med 2017; 45: 51–3.
28. Alber KF, Dachsel M, Gilmore A, et al. Curriculum mapping for Focused Acute Medicine Ultrasound (FAMUS). Acute Med 2018; 17: 164–7.