Cardiovascular Diseases & Diagnosis

Background: The COVID-19 pandemic exacerbated a preexisting backlog of outpatient echocardiogram orders at our academic safety-net healthcare system. We developed a unique model of utilization review for outpatient echocardiogram orders using appropriate use criteria (AUC) to improve health system-wide efficiency of cardiovascular imaging delivery and resource management.

Methods: Senior cardiology fellows were hired to prospectively review 4075 outpatient echocardiogram orders placed between January 1, 2020 and April 1, 2021. The order date, specialty and clinical setting of the ordering provider, and rationale for each order were determined, and orders were approved or canceled based on our AUC. Ordering providers received individualized messages informing them of the order review outcome and rationale for each decision. The resultant cost savings were estimated based on publicly available data. Average wait times from order to completion of the study were noted at the beginning and end of the study period.

Results: Of all reviewed orders, 32% (n=1304) were deemed inappropriate and 68% (n=2771) were deemed appropriate based on our proprietary AUC. Primary care accounted for the largest proportion of ordered exams (54%, n=2225), followed by cardiology (28%, n=1151). Average time from order placement to completion fell from 6mo at the onset of the study to 1.5mo at end of the study period. An institutional cost analysis demonstrated realized cost savings of $61,328.75 during the study period and projected savings of $107,637.60 annually if echocardiogram volumes were to return to pre-pandemic levels.

Conclusion: Our utilization review significantly improved appropriateness of studies performed while reducing echocardiography volume, wait times, and expenditures. This approach may be generalizable to other resource-limited healthcare systems and has potential to have an enduring impact on the practice of echocardiography even in a post-pandemic era.