Cardiology fellow here. Under normal circumstances, there is essentially no threshold to ordering a transthoracic echo at our hospital. Services like trauma sometimes order multiple TTEs a day on their patients for extremely soft indications, but we don't stop it unless it's particularly egregious.
With COVID coming into play, we are overall tightening up our requirements to get an echo – we are requiring at least a legitimate reason other than "eval squeeze". On the Covid rule out and positive patients, we are refusing echos unless they will clearly change acute management (ie: tamponade, MI). This has resulted in a great deal of turmoil and arguments between cardiology and other divisions.
We recently had a request for a stat overnight echo from one of my cofellows for a PUI to eval for LV thrombus in a guy who had a stroke and evidence of Biv dilation on a CT chest. A soft indication for sure. And it resulting in a shouting match between attendings and ultimately the fellow went in and did the study, putting himself at unnecessary risk.
We are even talking about potentially pushing fibrinolytics in "stable" STEMI Covid patients instead of bringing them to the cath lab. I have no idea what the poor folks in radiology are doing as I'm sure the Covid rule out and positive patients are getting tons of imaging.
What is everyone else out there doing?
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