Diagnostic point-of-care ultrasound in medical inpatients at Queen Elizabeth Central Hospital, Malawi: an observational study of practice and evaluation of implementation

Abstract Background In less well-resourced settings, where access to radiology services is limited, point-of-care ultrasound (POCUS) can be used to assess patients and guide clinical management. The aim of this study was to describe ultrasound practice in the assessment of medical inpatients at Queen Elizabeth Central Hospital, Blantyre, Malawi, and evaluate uptake and impact of POCUS following the introduction of a training programme at the college of Medicine, Blantyre, Malawi. Methods : A weekly prospective record review of sequential adult medical inpatients who had received an ultrasound examination was conducted. Results Of 835 patients screened, 250 patients were included; 267 ultrasound examinations were performed, of which 133 (50%) were POCUS (defined as performed by a clinician at the bedside). The time from request to performance of examination was shorter for POCUS examinations than radiology department ultrasound (RDUS) (median 0 [IQR 0–2, range 0–11] vs 2 [IQR 1–4, range 0–15] d, p=0.002); 104/133 (78.2%) POCUS and 90/133 (67.7%) RDUS examinations were deemed to have an impact on management. Conclusion Following the introduction of a training programme in POCUS, half of all ultrasound examinations were delivered as POCUS. POCUS was performed rapidly and impacted on patient management. POCUS may relieve the burden on radiology services in less well-resourced settings.

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145 Point of care lung ultrasound in patient triage: integration of ultrasound into a streaming pathway for COVID-19

Emergency Medicine Journal ◽

10.1136/emj-2020-rcemabstracts.27 ◽

2020 ◽

Vol 37 (12) ◽

pp. 839.1-839

Author(s):

Dominic Craver ◽

Aminah Ahmad ◽

Anna Colclough

Keyword(s):

Point Of Care ◽

District General Hospital ◽

Training Programme ◽

Service Evaluation ◽

University Hospital ◽

Junior Doctors ◽

Point Of Care Ultrasound ◽

Face To Face ◽

Point Of Care Diagnostics ◽

Audit Data

Aims/Objectives/BackgroundRapid risk stratification of patients is vital for Emergency Department (ED) streaming during the COVID-19 pandemic. Ideally, patients should be split into red (suspected/confirmed COVID-19) and green (non COVID-19) zones in order to minimise the risk of patient-to-patient and patient-to-staff transmission. A robust yet rapid streaming system combining clinician impression with point-of-care diagnostics is therefore necessary.Point of care ultrasound (POCUS) findings in COVID-19 have been shown to correlate well with computed tomography (CT) findings, and it therefore has value as a front-door diagnostic tool. At University Hospital Lewisham (a district general hospital in south London), we recognised the value of early POCUS and its potential for use in patient streaming.Methods/DesignWe developed a training programme, ‘POCUS for COVID’ and subsequently integrated POCUS into streaming of our ED patients. The training involved Zoom lectures, a face to face practical, a 10 scan sign off process followed by a final triggered assessment. Patient outcomes were reviewed in conjunction with their scan reports.Results/ConclusionsCurrently, we have 21 ED junior doctors performing ultrasound scans independently, and all patients presenting to our department are scanned either in triage or in the ambulance. A combination of clinical judgement and scan findings are used to stream the patient to an appropriate area.Service evaluation with analysis of audit data has found our streaming to be 94% sensitive and 79% specific as an indicator of COVID 19. Further analysis is ongoing.Here we present both the structure of our training programme and our integrated streaming pathway along with preliminary analysis results.

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Point-of-care lactate and creatinine analysis for sick obstetric patients at Queen Elizabeth Central Hospital in Blantyre, Malawi: A feasibility study

Malawi Medical Journal ◽

10.4314/mmj.v28i1.4 ◽

2016 ◽

Vol 28 (1) ◽

pp. 15 ◽

Cited By ~ 5

Author(s):

SA Glasmacher ◽

P Bonongwe ◽

W Stones

Keyword(s):

Feasibility Study ◽

Point Of Care ◽

Central Hospital ◽

Queen Elizabeth Central Hospital

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Point‐of‐care ultrasound in rural New Zealand: Safety, quality and impact on patient management

Australian Journal of Rural Health ◽

10.1111/ajr.12472 ◽

2018 ◽

Vol 26 (5) ◽

pp. 342-349 ◽

Cited By ~ 5

Author(s):

Garry Nixon ◽

Katharina Blattner ◽

Marara Koroheke‐Rogers ◽

Jillian Muirhead ◽

Wendy L. Finnie ◽

...

Keyword(s):

New Zealand ◽

Patient Management ◽

Point Of Care ◽

Point Of Care Ultrasound

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Routine Point of Care Ultrasound (POCUS) Assessment of Gastric Antral Contents in Traumatic Emergency Surgical Patients for Prevention of Aspiration Pneumonitis: A Randomized Clinical Trial

10.21203/rs.3.rs-125276/v1 ◽

2020 ◽

Author(s):

Mohamed S. Shorbagy ◽

Amr A. Kasem ◽

Ahmed A. Gamal Eldin ◽

Ramy Mahrose

Keyword(s):

Aspiration Pneumonia ◽

Nasogastric Tube ◽

Emergency Surgery ◽

Ultrasound Examination ◽

Point Of Care ◽

Stomach Contents ◽

Gastric Antrum ◽

Point Of Care Ultrasound ◽

Anesthesia Technique ◽

Polytrauma Patients

Abstract Background: Polytrauma patients are at a higher risk of delayed gastric emptying. To assess gastric volume, a reliable diagnostic tool is needed to prevent the occurrence of aspiration pneumonia, which remains a serious complication associated with anesthesia. Gastric antral ultrasound can provide reliable information about the size of the gastric antrum in traumatized patients undergoing emergency surgery.Methods: A prospective observational study of 45 polytrauma patients undergoing emergency surgery under general anesthesia. Prior to induction of anesthesia in the emergency department, gastric ultrasound was performed to allow qualitative and quantitative assessment of gastric antrum in a supine position and right lateral decubitus (RLD) position. Followed by routine placement of nasogastric tube to aspirate and calculate the volume of the stomach contents.Results: Forty-five polytrauma patients who underwent gastric ultrasound examination showed that the risk assessment of aspiration and anesthesia technique changed in 14 patients (31.1%) after the ultrasound examination.A very good relationship existed between the expected stomach volume at the RLD position and the suction volume in the nasogastric tube. In all cases, no aspirations were documented.Conclusion: Ultrasound examination of the stomach in polytrauma patients allows assessing the size and type of stomach contents. The data obtained can influence the choice of anesthesia technique while inducing anesthesia and reduce the risk of aspiration pneumonia.Trial registration: This trial was registered at ClinicalTrials.gov. Registry number: NCT04083677.

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Governance in point-of-care ultrasound

Focused Intensive Care Ultrasound ◽

10.1093/med/9780198749080.003.0034 ◽

2019 ◽

pp. 273-278

Author(s):

Peter Macnaughton ◽

Marcus Peck

Keyword(s):

Intensive Care Unit ◽

Patient Safety ◽

Intensive Care ◽

Ultrasound Examination ◽

Point Of Care ◽

Good Practice ◽

Point Of Care Ultrasound ◽

Equipment Management ◽

Image Storage ◽

Ensure Patient Safety

The performance and interpretation of ultrasound examination are very user-dependent that require significant training and experience. This chapter details the processes that should be adopted within an intensive care unit using point-of-care ultrasound to ensure that practitioners are appropriately trained and are able to maintain and develop their skills. The chapter also outlines recommendations regarding good practice in reporting and image storage, together with guidance regarding equipment management, to ensure patient safety.

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POINT: Should Point-of-Care Ultrasound Examination Be Routine Practice in the Evaluation of the Acutely Breathless Patient? Yes

CHEST Journal ◽

10.1016/j.chest.2019.04.118 ◽

2019 ◽

Vol 156 (3) ◽

pp. 424-426 ◽

Cited By ~ 5

Author(s):

Seth Koenig ◽

Adey Tsegaye

Keyword(s):

Ultrasound Examination ◽

Point Of Care ◽

Routine Practice ◽

Point Of Care Ultrasound

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Model Point-of-Care Ultrasound Curriculum in an Intensive Care Unit Fellowship Program and Its Impact on Patient Management

Critical Care Research and Practice ◽

10.1155/2014/934796 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Keith Killu ◽

Victor Coba ◽

Michael Mendez ◽

Subhash Reddy ◽

Tanja Adrzejewski ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Patient Care ◽

Patient Management ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Fellowship Program ◽

Icu Patients ◽

Surgical Icu ◽

New Diagnosis

Objectives. This study was designed to assess the clinical applicability of a Point-of-Care (POC) ultrasound curriculum into an intensive care unit (ICU) fellowship program and its impact on patient care.Methods. A POC ultrasound curriculum for the surgical ICU (SICU) fellowship was designed and implemented in an urban, academic tertiary care center. It included 30 hours of didactics and hands-on training on models. Minimum requirement for each ICU fellow was to perform 25–50 exams on respective systems or organs for a total not less than 125 studies on ICU. The ICU fellows implemented the POC ultrasound curriculum into their daily practice in managing ICU patients, under supervision from ICU staff physicians, who were instructors in POC ultrasound. Impact on patient care including finding a new diagnosis or change in patient management was reviewed over a period of one academic year.Results. 873 POC ultrasound studies in 203 patients admitted to the surgical ICU were reviewed for analysis. All studies included were done through the POC ultrasound curriculum training. The most common exams performed were 379 lung/pleural exams, 239 focused echocardiography and hemodynamic exams, and 237 abdominal exams. New diagnosis was found in 65.52% of cases (95% CI 0.590, 0.720). Changes in patient management were found in 36.95% of cases (95% CI 0.303, 0.435).Conclusions. Implementation of POC ultrasound in the ICU with a structured fellowship curriculum was associated with an increase in new diagnosis in about 2/3 and change in management in over 1/3 of ICU patients studied.

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Point of Care Ultrasound First: An Opportunity to Improve Efficiency for Uncomplicated Pregnancy in the Emergency Department

POCUS Journal ◽

10.24908/pocus.v6i1.14762 ◽

2021 ◽

Vol 6 (1) ◽

pp. 42-44

Author(s):

Sara Urquhart ◽

Kendall Stevens ◽

Mariah Barnes ◽

Matthew Flannigan

Keyword(s):

Emergency Department ◽

Random Sample ◽

Medical Center ◽

Point Of Care ◽

Tertiary Care ◽

Radiology Department ◽

Point Of Care Ultrasound ◽

Tertiary Care Medical Center ◽

Time To Diagnosis ◽

Emergency Department Patients

Introduction: Research suggests emergency providers using point-of-care ultrasound (POCUS) to confirm an uncomplicated intrauterine pregnancy (IUP) can decrease emergency department (ED) length of stay (LOS) compared to a radiology department ultrasound (RADUS). The objective of this study was to compare the time to diagnosis and LOS between POCUS and RADUS patients. Methods: This was a retrospective study at one urban medical center. A standardized tool was used to abstract data from a random sample of pregnant patients diagnosed with uncomplicated IUP between January 2016 and December 2017 at a single tertiary care medical center. Microsoft Excel 2010 software was used to measure time intervals, prepare descriptive statistics, and perform Mann-Whitney U tests to compare differences. Results: A random sample of 836 (36%) of the 2,346 emergency department patients diagnosed with an IUP between 8-20 weeks’ gestation during the study period was evaluated for inclusion. Three hundred sixty-six met inclusion criteria and were included in the final analysis. Patients were divided into 2 groups based on which type of ultrasound scan they received first: POCUS (n=165) and RADUS (n=201). Patients who received POCUS were found to have an IUP identified in an average of 48 minutes (95% CI, 43 to 53), while the RADUS group’s mean time to diagnosis was 120 minutes (95% CI 113 to 127) with a difference of 72 minutes (95% CI, 63 to 80; p<0.001). The mean LOS for patients who received POCUS was 132 minutes (95% CI, 122 to 142), while that of the RADUS group was 177 minutes (95% CI 170 to 184) with a difference of 45 minutes (95% CI 32 to 56; p<0.001). The study is limited by its single-center, retrospective design and by lack of blinding of data abstractors. Conclusion: Pregnant emergency department patients diagnosed with an uncomplicated IUP between 8-weeks and 20-weeks’ gestation had statistically significant reduction in time to diagnosis and disposition from the ED if assessed with POCUS as compared to RADUS.

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The Role and Challenges of Clinical Imaging During COVID-19 Outbreak

Journal of Diagnostic Medical Sonography ◽

10.1177/87564793211056903 ◽

2021 ◽

pp. 875647932110569

Author(s):

Mustafa Alhasan ◽

Mohamed Hasaneen

Keyword(s):

Infection Control ◽

Imaging Modality ◽

Point Of Care ◽

Limiting Factors ◽

Disease Stage ◽

Radiology Department ◽

Point Of Care Ultrasound ◽

Signal Loss ◽

Clinical Utilization ◽

Precautionary Measures

Objective: The Radiology department played a crucial role in detecting and following up with the COVID-19 disease during the pandemic. The purpose of this review was to highlight and discuss the role of each imaging modality, in the radiology department, that can help in the current pandemic and to determine the challenges faced by staff and how to overcome them. Materials and Methods: A literature search was performed using different databases, including PubMed, Google scholar, and the college electronic library to access 2020 published related articles. Results: A chest computed tomogram (CT) was found to be superior to a chest radiograph, with regards to the early detection of COVID-19. Utilizing lung point of care ultrasound (POCUS) with pediatric patients, demonstrated excellent sensitivity and specificity, compared to a chest radiography. In addition, lung ultrasound (LUS) showed a high correlation with the disease severity assessed with CT. However, magnetic resonance imaging (MRI) has some limiting factors with regard to its clinical utilization, due to signal loss. The reported challenges that the radiology department faced were mainly related to infection control, staff workload, and the training of students. Conclusion: The choice of an imaging modality to provide a COVID-19 diagnosis is debatable. It depends on several factors that should be carefully considered, such as disease stage, mobility of the patient, and ease of applying infection control procedures. The pros and cons of each imaging modality were highlighted, as part of this review. To control the spread of the infection, precautionary measures such as the use of portable radiographic equipment and the use of personal protective equipment (PPE) must be implemented.

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