London, ON, Canada, London Ontario, Canada

Transcription

1 P-94 THE EFFECT OF CRITICAL CARE ECHOCARDIOGRAPHY ON THE USAGE RATES OF DIAGNOSTIC ECHOCARDIOGRAPHY IN THE INTENSIVE CARE UNIT Alherbish, Aws 1 ; Priestap, Fran 1 ; Arntfield, Robert 1 1 Critical Care Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada, London Ontario, Canada Introduction: Critical care echocardiography (CCE) is routinely used by intensive care unit (ICU) providers to provide real time interpretation and integration of findings into patient care. By comparison, diagnostic echocardiography (DE) employs a comprehensive examination with a more traditional imaging workflow and sophisticated techniques not included in CCE. Despite these differences, CCE and DE are frequently employed to answer similar diagnostic questions that arise in the ICU. This overlap raises questions of duplicate testing, which may result in redundancy of hospital resources and patient morbidity through over-testing. An examination of the utilization patterns of these modalities in the ICU and, in particular, how the advent of CCE may influence the use of DE is of great interest. Objectives: To evaluate the effect of the introduction of CCE over the utilization of DE in tertiary care ICUs from 2 hospitals: University hospital (UH) and Victoria hospital (VH). To examine if a change in trend (if any) had resulted in any change in outcomes. Methods: The monthly mean ratios of CCE and DE studies to patient care days (PCD) were plotted and general linear models were used to test for trends over time. Student's t-test was used to compare the mean ratio of DE studies to PCD before and after the introduction of CCE. Outcome measures were compared using Pearson s chi-square test of association or the Wilcoxon Rank Sum test, where applicable. Results: Whereas the ratio of CCE/PCD increased significantly and the ratio of DE/PCD decreased significantly over time at VH (p= and p= respectively), they did not change significantly over time at UH (p=0.11 and p=0.81 respectively) (Figure 1). The mean ratio of DE/PCD decreased significantly between pre CCE and post CCE periods at VH (5.27% to 4.51%, p=0.011) while insignificant decrease was seen at UH (5.90% to 5.79%, p=0.689) (Table 1). At both hospitals, there was no significant increase in ICU mortality or LOS when comparing the pre to post CCE periods. At VH, ICU mortality was (23.69% and 24.61% pre and post CCE respectively, p=0.479) and median LOS was (4.18 and 3.53 pre and post CCE respectively, p Conclusion: Significant CCE utilization is associated with a significant decrease in utilization of DE in an academic ICU environment with no influence on outcomes. References: 1. Cholley BP, Vieillard-Baron A, Mebazaa A. Echocardiography in the ICU: time for widespread use! Intensive Care Med 2006;32(1): Beaulieu Y. Bedside echocardiography in the assessment of the critically ill. Crit Care Med 2007;35(5 Suppl):S Beaulieu Y. Specific skill set and goals of focused echocardiography for critical care clinicians. Crit Care Med 2007;35(5 Suppl):S Breitkreutz R, Walcher F, Seeger FH. Focused echocardiographic evaluation in resuscitation management: concept of an advanced life support-conformed algorithm. Crit Care Med 2007;35(5 Suppl):S Arntfield RT, Millington SJ. Point of care cardiac ultrasound applications in the emergency department and intensive care unit--a review. Curr Cardiol Rev;8(2): Kaplan A, Mayo PH. Echocardiography performed by the pulmonary/critical care medicine physician. Chest 2009;135(2): International expert statement on training standards for critical care ultrasonography. Intensive Care Med;37(7): International consensus statement on

2 training standards for advanced critical care echocardiography. Intensive Care Med;40(5): Young GB, Sharpe MD, Savard M, Al Thenayan E, Norton L, Davies-Schinkel C. Seizure detection with a commercially available bedside EEG monitor and the subhairline montage. Neurocrit Care 2009;11(3): Tanner AE, Sarkela MO, Virtanen J, Viertio-Oja HE, Sharpe MD, Norton L, et al. Application of subhairline EEG montage in intensive care unit: comparison with full montage. J Clin Neurophysiol;31(3): Beaulieu Y, Marik PE. Bedside ultrasonography in the ICU: part 2. Chest 2005;128(3): Beaulieu Y, Marik PE. Bedside ultrasonography in the ICU: part 1. Chest 2005;128(2): Kanji HD, McCallum J, Sirounis D, MacRedmond R, Moss R, Boyd JH. Limited echocardiography-guided therapy in subacute shock is associated with change in management and improved outcomes. J Crit Care. 14. Orme RM, Oram MP, McKinstry CE. Impact of echocardiography on patient management in the intensive care unit: an audit of district general hospital practice. Br J Anaesth 2009;102(3): Stanko LK, Jacobsohn E, Tam JW, De Wet CJ, Avidan M. Transthoracic echocardiography: impact on diagnosis and management in tertiary care intensive care units. Anaesth Intensive Care 2005;33(4): Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr;26(6): Manasia AR, Nagaraj HM, Kodali RB, Croft LB, Oropello JM, Kohli-Seth R, et al. Feasibility and potential clinical utility of goal-directed transthoracic echocardiography performed by noncardiologist intensivists using a small hand-carried device (SonoHeart) in critically ill patients. J Cardiothorac Vasc Anesth 2005;19(2): Mark DG, Hayden GE, Ky B, Paszczuk A, Pugh M, Matthews S, et al. Hand-carried echocardiography for assessment of left ventricular filling and ejection fraction in the surgical intensive care unit. J Crit Care 2009;24(3):470 e Melamed R, Sprenkle MD, Ulstad VK, Herzog CA, Leatherman JW. Assessment of left ventricular function by intensivists using hand-held echocardiography. Chest 2009;135(6): Prinz C, Dohrmann J, van Buuren F, Bitter T, Bogunovic N, Horstkotte D, et al. The importance of training in echocardiography: a validation study using pocket echocardiography. J Cardiovasc Med (Hagerstown);13(11): Zhang LN, Ai YH, Liu ZY, Tian CH, Zhu JX. [Feasibility of focused transthoracic echocardiography in intensive care unit performed by intensivists]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue;24(12):

3 Figure 1: CCE/PCD (A) and DE/PCD (B) trends over time at VH A p= B p=0.0037

4 Figure 2: CCE/PCD (A) and DE/PCD (B) trends over time at UH A p= B p=0.8194

5 Table 1 Outcome VH UH Pre-CCE Post-CCE Pre-CCE Post-CCE DE/PCD* 5.27% 4.51% 5.9% 5.79% ICU mortality* 23.7% 24.6% 23.3% 23.4% ICU LOS** * Mean percentage, ** Median days