Hello team!
As part of the AQSI Central program last year, our project called Leggo My Echo had the goal to reduce the overuse of inpatient echos (TTE’s) for low-risk, non-cardiac syncope. Mike Jiang and Pamela Wax helped develop this initiative under the leadership of David Goese, one of the hospital medicine attendings here at NMH.
We wanted to share changes that are being implemented to Epic to the Inpatient Echocardiogram order related to our project. Attached is an Epic Tip Sheet attached which explains them.
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Open in new tab The Epic changes are meant to encourage appropriate, thoughtful use of inpatient echos for syncope; and the data generated could possibly lead to future quality improvement project ideas. The Epic go-live date is Friday 2/11/22.
The following describes the changes which include adding the Canadian Syncope Risk Score to Epic, modifying the inpatient echo order to include indications rather than a free text “reason for ordering”, and a targeted BPA that fires when an echo is ordered for syncope.
We recommend filling out the Canadian Syncope Risk Score when ordering an echo for syncope when you are not sure if syncope could be cardiac or not. If the Canadian Syncope Risk Score is low or very low, then this can reassure that the echo likely is not needed.
Epic changes:
- The inpatient echo (TTE) order will include buttons for reasons for ordering
- We hope this is equal or if anything faster than filling out previous echo order, which required filling out “Reason for echocardiogram” as free text. This should not change workflow significantly, please reach out if you feel it does
- If the indication is not listed, choose “Other” and write in the comments the reason for ordering
- We looked through hundreds of echos, grouped indications, included all the most common and worked with cardiology contacts on them so we hope the buttons will capture almost all reasons for ordering.
- Added the Canadian Syncope Risk Score to Epic to Scoring Tools tab
- The Scoring Tools tab, which is a Tab on the top part of Epic, will now have the Canadian Syncope Risk Score which can be filled out and documented
- Scoring Tools was previously only available to Emergency Medicine physicians, now has expanded to all clinicians. This tab includes scoring tools like HEART score for chest pain or COWS for opioid withdrawal.
- We added a targeted BPA which displays the Canadian Syncope Risk Score along with relevant vitals/lab/EKG data to make it as easy as possible to fill out the score.
- This BPA can be bypassed by clicking “Do Not Document”, in the case that you have suspicion for cardiac syncope and you are sure you want to do an echo
We would be happy to discuss more or arrange a demo at a faculty/residency meeting if it would interest anyone. Also, please email any feedback, suggestions, or collaboration ideas to Mike, Pamela, or David. We are hoping to reassess the changes in 1-2 months and make sure to address any issues that come up.
TL:DR – The Epic tip sheet attached explains changes to the inpatient echo order and adding the Canadian Syncope Risk Score to Epic for a quality improvement project on reducing the overuse of inpatient echos for low-risk non-cardiac syncope, which are going live on 2/11/22.
Thanks,
Mike, Pamela, and David on behalf of the AQSI Leggo My Echo Team