title: Appropriate use of echocardiography in an Australian regional centre.
abstract: BACKGROUND
  The 2011 Appropriate Use Criteria (AUC) were developed by the American Society of Echocardiography (ASE) to provide guidance for referring physicians in response to growing concerns about unnecessary transthoracic echocardiogram (TTE) requests. When applied in multiple centres overseas, the rate of inappropriate referrals was as high as 22%.
  
  
  OBJECTIVE
  To assess the applicability of, and the level of adherence to the 2011 AUC in an Australian regional hospital where the AUC have not been tested systematically.
  
  
  METHODS
  A retrospective analysis of 1000 inpatient and outpatient TTE referrals was conducted between January 2014 and June 2014 at Bendigo Hospital, a major regional referral hospital.
  
  
  RESULTS
  Ninety-eight percent of the TTE referrals were classifiable. The most common indication for ordering TTE was to evaluate symptoms potentially related to a cardiac aetiology. Of the classifiable referrals, 77% were appropriate, 20.3% were inappropriate and 2.7% were uncertain. The most common inappropriate indications were routine surveillance of the left ventricular (LV) function in stable chronic cardiac conditions and routine perioperative evaluation of the LV function with no symptoms or signs of cardiovascular disease. Inappropriate referrals were significantly more frequent in outpatients compared with inpatients (24.4% vs 9.6%, P < 0.001).
  
  
  CONCLUSIONS
  This study provides a novel insight into the ordering of TTEs in regional Australia. In this study, one in five referrals had an inappropriate indication and could be avoided. This may have significant implications for healthcare resources in regional centres, and strategies to reduce inappropriate echocardiography ordering need to be implemented.
authors.affiliation: Department of Cardiology, Bendigo Health, Bendigo, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Al-Kaisey
authors.affiliation: Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Jones
authors.affiliation: Department of Cardiology, Bendigo Health, Bendigo, Australia.
authors.forename: V
authors.initials: V
authors.lastname: Nadurata
authors.affiliation: Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.
authors.forename: O
authors.initials: O
authors.lastname: Farouque
authors.affiliation: Department of Cardiology, Bendigo Health, Bendigo, Australia.
authors.forename: D
authors.initials: D
authors.lastname: De Silva
authors.affiliation: Department of Cardiology, Bendigo Health, Bendigo, Australia.|Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Ramchand
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D004452:Echocardiography / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006769:Hospitals, General / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation / Q000592:standards*; D012189:Retrospective Studies; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
keywords: appropriate use criteria; cardiac imaging; coronary artery disease; echocardiography; heart failure