The introduction of basic critical care echocardiography reduces the use of diagnostic echocardiography in the intensive care unit.
BACKGROUND
Basic critical care echocardiography (CCE) is routinely used by intensive care unit (ICU) providers to rapidly address key hemodynamic questions for the critically ill. By comparison, diagnostic echocardiography (DE) uses a comprehensive examination with more traditional workflow and sophisticated techniques. Despite these differences, both are frequently used to answer similar questions in ICU. This overlap raises questions of duplicate testing and redundancy of hospital resources. We therefore evaluated the effect of the introduction of basic CCE over the use of DE in Victoria Hospital, a tertiary care ICU in London Ontario, Canada.


METHODS
The monthly mean ratios of basic CCE and DE studies to patient care days (PCD) were plotted and general linear models were used to test for trends over time. Student t test was used to compare the mean DE/PCD before and after the introduction of basic CCE. The ratio of management actions for basic CCE studies was described. Outcome measures were compared using Pearson χ(2) test of association or the Wilcoxon rank sum test.


RESULTS
Over the 2-year study period, 1264 basic CCE studies were performed. Over this time, the ratio of CCE/PCD increased significantly (P<.001), whereas the ratio of DE/PCD decreased significantly (P=.004). When comparing the pre- and post-CCE periods, the mean DE/PCD decreased significantly from 5.27% to 4.51% (P=.01). There was no adverse change in ICU outcomes before and after the introduction of basic CCE. Mortality rates (pre- and post-CCE) were 23.69% and 24.61% (P=.48); median length of stay was 4.18 and 3.53 days (P<.001); and ventilated patient day rate was 64.96% and 64.93% (P>.9). There was a significant increase in vasoactive/inotropic drugs from a 20.47% vasoactive/inotropic drug/patient day rate to 21.99% (P<.001). Of all basic CCE studies, 61% led to a specific management action, including ordering a DE in 10.7% of cases.


CONCLUSIONS
In a hospital with a significant increase in basic CCE use, an associated significant decrease in DE use was observed with no increase in adverse outcomes. The significant increase in basic CCE use resulted in a change of management in most cases including the request for DE in a minority of cases.
Department of Medicine, Division of Critical Care, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada. Electronic address: aws.alherbish@londonhospitals.ca.
Aws
A
Alherbish
Department of Medicine, Division of Critical Care, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada. Electronic address: fran.priestap@lhsc.on.ca.
Fran
F
Priestap
Department of Medicine, Division of Critical Care, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada. Electronic address: robert.arntfield@gmail.com.
Robert
R
Arntfield
D000368:Aged; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009864:Ontario; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013997:Time Factors
Cardiovascular imaging; Critical care echocardiography; Diagnostic echocardiography; New technology; Resource use; Ultrasound