Determinants of Resource Utilization in a Tertiary Pediatric and Congenital Echocardiographic Laboratory

We sought to determine the relation between technical charges for transthoracic echocardiograms (TTE) and total time for study completion (TT), identify factors associated with high TT, and create a scoring system to predict high TT studies. We analyzed a quality improvement database that prospectively tracked patient flow through TTEs in our laboratory for 3 consecutive months. The performing sonographer or fellow recorded TT and its components for every study. Patient and scan characteristics were abstracted from the clinical database and technical charges from the financial database. Factors independently associated with high TT (top quartile ≥85 minutes) were identified in 1,686 studies and validated in the remaining 847 studies. Median age was 7.8 years (0 to 77.9) and median TT was 65 minutes (14 to 370 minutes). Charges correlated poorly with TT (r = 0.2). Multivariate analysis identified several independent factors associated with high TT. The final model had an area under the curve of 0.78 in the development sample and 0.75 in the validation sample. On the basis of the final model, we developed a risk score for TT ≥85 minutes. The prevalence of high TT was 15% in low-score studies, 51% in medium-score studies, and 81% in high-score studies. In conclusion, this is the first study to demonstrate poor correlation between technical charges for pediatric/congenital echocardiography and TT, identify risk factors for high TT, and develop a high TT risk scoring system. These data may assist in resource allocation for pediatric/congenital echocardiograms and inform reimbursement systems.