{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T11:37:50Z","timestamp":1778585870014,"version":"3.51.4"},"reference-count":19,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2015,9,1]]},"published-print":{"date-parts":[[2016,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Guidance for appropriate utilisation of transthoracic echocardiograms (TTEs) can be incorporated into ordering prompts, potentially affecting the number of requests.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We incorporated data from the 2011 Appropriate Use Criteria for Echocardiography, the 2010 National Institute for Clinical Excellence Guideline on Chronic Heart Failure, and American College of Cardiology Choosing Wisely list on TTE use for dyspnoea, oedema and valvular disease into electronic ordering systems at Durham Veterans Affairs Medical Center. Our primary outcome was TTE orders per month. Secondary outcomes included rates of outpatient TTE ordering per 100 visits and frequency of brain natriuretic peptide (BNP) ordering prior to TTE. Outcomes were measured for 20\u2005months before and 12\u2005months after the intervention.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The number of TTEs ordered did not decrease (338\u00b132 TTEs\/month prior vs 320\u00b133 afterwards, p=0.12). Rates of outpatient TTE ordering decreased minimally post intervention (2.28 per 100 primary care\/cardiology visits prior vs 1.99 afterwards, p&lt;0.01). Effects on TTE ordering and ordering rate significantly interacted with time from intervention (p&lt;0.02 for both), as the small initial effects waned after 6\u2005months. The percentage of TTE orders with preceding BNP increased (36.5% prior vs 42.2% after for inpatients, p=0.01; 10.8% prior vs 14.5% after for outpatients, p&lt;0.01).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Ordering prompts for TTEs initially minimally reduced the number of TTEs ordered and increased BNP measurement at a single institution, but the effect on TTEs ordered was likely insignificant from a utilisation standpoint and decayed over time.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjqs-2015-004284","type":"journal-article","created":{"date-parts":[[2015,9,24]],"date-time":"2015-09-24T23:24:50Z","timestamp":1443137090000},"page":"57-62","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Guideline-based decision support has a small, non-sustained effect on transthoracic echocardiography ordering frequency"],"prefix":"10.1136","volume":"25","author":[{"given":"Joel C","family":"Boggan","sequence":"first","affiliation":[{"name":"Department of Medicine, Durham VA Medical Center, Durham, North Carolina, USA"},{"name":"Department of Medicine, Duke University Health System, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan D","family":"Schulteis","sequence":"additional","affiliation":[{"name":"Department of Medicine, Durham VA Medical Center, Durham, North Carolina, USA"},{"name":"Department of Medicine, Duke University Health System, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Donahue","sequence":"additional","affiliation":[{"name":"Department of Medicine, Durham VA Medical Center, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David L","family":"Simel","sequence":"additional","affiliation":[{"name":"Department of Medicine, Durham VA Medical Center, Durham, North Carolina, USA"},{"name":"Department of Medicine, Duke University Health System, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2015,9,24]]},"reference":[{"key":"2025090409333430000_25.1.57.1","unstructured":"American College of Cardiology. American College of Cardiology: Five Things Physicians and Patients Should Question. http:\/\/www.choosingwisely.org\/doctor-patient-lists\/american-college-of-cardiology\/ (accessed 5 Jul 2014)."},{"key":"2025090409333430000_25.1.57.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.11.002"},{"key":"2025090409333430000_25.1.57.3","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.8972"},{"key":"2025090409333430000_25.1.57.4","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.111.961813"},{"key":"2025090409333430000_25.1.57.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2011.03.030"},{"key":"2025090409333430000_25.1.57.6","doi-asserted-by":"publisher","DOI":"10.1001\/2013.jamainternmed.727"},{"key":"2025090409333430000_25.1.57.7","unstructured":"National Institute for Health and Care Excellence. 2010. Chronic heart failure: management of chronic heart failure in adults in primary and secondary care. CG108. London: National Institute for Health and Care Excellence."},{"key":"2025090409333430000_25.1.57.8","doi-asserted-by":"publisher","DOI":"10.3310\/hta13320"},{"key":"2025090409333430000_25.1.57.9","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2010.220426"},{"key":"2025090409333430000_25.1.57.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2013.01.010"},{"key":"2025090409333430000_25.1.57.11","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/j.jcmg.2014.04.014","article-title":"Educational intervention to reduce outpatient inappropriate echocardiograms","volume":"7","author":"Bhatia","year":"2014","journal-title":"JACC Cardiovasc Imaging"},{"key":"2025090409333430000_25.1.57.12","unstructured":"R Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; 2014."},{"key":"2025090409333430000_25.1.57.13","unstructured":"Gitlow H , Gitlow S , Oppenheim A , et al . Tools and methods for the improvement of quality. Homewood, IL. Richard D. Irwin Inc, 1989."},{"key":"2025090409333430000_25.1.57.14","unstructured":"Montgomery DC . 2013. Introduction to statistical quality control. 7th edn. Hoboken, NJ. John Wiley and Sons."},{"key":"2025090409333430000_25.1.57.15","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-157-1-201207030-00450"},{"key":"2025090409333430000_25.1.57.16","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6947-13-43"},{"key":"2025090409333430000_25.1.57.17","doi-asserted-by":"publisher","DOI":"10.1111\/echo.12505"},{"key":"2025090409333430000_25.1.57.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2009.12.015"},{"key":"2025090409333430000_25.1.57.19","doi-asserted-by":"publisher","DOI":"10.3109\/03009734.2012.751471"}],"container-title":["BMJ Quality &amp; Safety"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjqs-2015-004284","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T16:33:45Z","timestamp":1757003625000},"score":1,"resource":{"primary":{"URL":"https:\/\/qualitysafety.bmj.com\/lookup\/doi\/10.1136\/bmjqs-2015-004284"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,9,24]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2015,12,15]]},"published-print":{"date-parts":[[2016,1]]}},"alternative-id":["10.1136\/bmjqs-2015-004284"],"URL":"https:\/\/doi.org\/10.1136\/bmjqs-2015-004284","relation":{},"ISSN":["2044-5415","2044-5423"],"issn-type":[{"value":"2044-5415","type":"print"},{"value":"2044-5423","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,9,24]]}}}