Background: Carotid artery Doppler ultrasound is a valuable diagnostic tool for patients with neurological symptoms suggestive of cerebrovascular disease, such as transient ischemic attack (TIA), stroke, or focal neurological deficits. However, its diagnostic utility is limited in patients presenting with non-specific symptoms such as syncope, dizziness, or headache. Unnecessary Doppler orders in these cases can lead to inefficient use of hospital resources, prolonged hospitalizations, and diminished capacity for radiology technologists to perform higher-yield studies. At our community teaching hospital in Queens, New York, we aimed to reduce unnecessary Doppler orders while improving job satisfaction for technologists.
Purpose: This project aimed to reduce the ordering of inappropriate carotid artery Doppler ultrasounds by aligning hospital practices with evidence-based guidelines. Specifically, we sought to reserve Doppler use for cases with established indications, such as TIA, stroke, or syncope with neurological signs or symptoms suggestive of a cerebrovascular cause. By refining practice standards, we aimed to improve the quality and efficiency of care, optimize resource utilization, and enhance job satisfaction among radiology technologists.
Description: We conducted an audit of carotid Doppler orders from January 2020 to July 2021, finding that of 857 Dopplers performed, only 63 detected at least mild carotid stenosis (7.4%), and only 2 patients (0.2%) underwent carotid endarterectomy. These findings demonstrated a low diagnostic yield, highlighting the need for more targeted ordering practices.In August 2021, we implemented a multi-faceted intervention and monitored Doppler orders through June 2024. Key components of the intervention included:• Collaboration with Neurology, Cardiology, and Radiology departments to establish evidence-based criteria.• Provider education on appropriate indications and feedback on ordering practices.• Engagement of hospital ultrasound technologists to review clinical indications for Doppler orders and to contact providers about orders that did not meet established criteria. Escalations were made to the Director of Hospital Medicine as needed .Annual data showed a steady decline in Doppler orders: 706 orders in 2019, 540 in 2020, 330 in 2021, 198 in 2022, 64 in 2023, and 20 from January to June 2024. The reduction in 2020 reflected the effects of the COVID-19 pandemic, which impacted patient volumes and testing priorities. The continued reduction in 2021 is partially attributed to our intervention, suggesting order volumes that year would have been higher without it.
Conclusions: From 2019 to 2023, we observed a 91% reduction in carotid Doppler orders (from 706 to 64 orders annually), demonstrating the sustained impact of our intervention. By decreasing unnecessary testing, we improved the efficiency of care, likely reduced patient length of stay, and enhanced radiology technologists’ job satisfaction by reducing the volume of low-yield studies.These findings highlight the value of a focused, data-driven approach to reducing unnecessary testing and optimizing resource use. Our model may be applicable to other areas of healthcare where overutilization impacts quality and efficiency.