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

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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Impact of point-of-care ultrasound on the hospital length of stay for internal medicine inpatients with cardiopulmonary diagnosis at admission: study protocol of a randomized controlled trial—the IMFCU-1 (Internal Medicine Focused Clinical Ultrasound) study

Trials ◽

10.1186/s13063-019-4003-2 ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Ximena Cid ◽

David Canty ◽

Alistair Royse ◽

Andrea B. Maier ◽

Douglas Johnson ◽

...

Keyword(s):

Internal Medicine ◽

Randomized Controlled Trial ◽

Length Of Stay ◽

Patient Management ◽

Point Of Care ◽

Controlled Trial ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Point Of Care Ultrasound ◽

Randomized Controlled

Abstract Background Point-of-care ultrasound (POCUS) is emerging as a reliable and valid clinical tool that impacts diagnosis and clinical decision-making as well as timely intervention for optimal patient management. This makes its utility in patients admitted to internal medicine wards attractive. However, there is still an evidence gap in all the medical setting of how its use affects clinical variables such as length of stay, morbidity, and mortality. Methods/design A prospective randomized controlled trial assessing the effect of a surface POCUS of the heart, lungs, and femoral and popliteal veins performed by an internal medicine physician during the first 24 h of patient admission to the unit with a presumptive cardiopulmonary diagnosis. The University of Melbourne iHeartScan, iLungScan, and two-point venous compression protocols are followed to identify left and right ventricular function, significant valvular heart disease, pericardial and pleural effusion, consolidation, pulmonary edema, pneumothorax, and proximal deep venous thrombosis. Patient management is not commanded by the protocol and is at the discretion of the treating team. A total of 250 patients will be recruited at one tertiary hospital. Participants are randomized to receive POCUS or no POCUS. The primary outcome measured will be hospital length of stay. Secondary outcomes include the change in diagnosis and management, 30-day hospital readmission, and healthcare costs. Discussion This study will evaluate the clinical impact of multi-organ POCUS in internal medicine patients admitted with cardiopulmonary diagnosis on the hospital length of stay. Recruitment of participants commenced in September 2018 and is estimated to be completed by March 2020. Trial registration Australian and New Zealand Clinical Trial Registry, ACTRN12618001442291. Registered on 28 August 2018.

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Impact of point-of-care ultrasound on the hospital length of stay for internal medicine inpatients with cardiopulmonary diagnosis at admission. – Study protocol of a randomized controlled trial: the IMFCU-1 (Internal Medicine Focused Clinical Ultrasound) study

10.21203/rs.2.12182/v1 ◽

2019 ◽

Author(s):

Ximena Anaite Cid ◽

David Canty ◽

Alistair Royse ◽

Andrea Maier ◽

Douglas Johnson ◽

...

Keyword(s):

Internal Medicine ◽

Randomized Controlled Trial ◽

Length Of Stay ◽

Patient Management ◽

Point Of Care ◽

Controlled Trial ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Point Of Care Ultrasound ◽

Randomized Controlled

Abstract Background Point-of-care ultrasound (POCUS) is emerging as a reliable and valid clinical tool that impacts diagnosis and clinical decision making, and timely intervention for optimal patient management. This makes its utility in patients admitted to internal medicine wards attractive. However, there is still an evidence gap in all the medical setting of how its use affects clinical variables such as length of stay, morbidity and mortality. Methods/design A prospective randomized controlled trial assessing the effect of a surface POCUS of the heart, lungs, and femoral and popliteal veins performed by an internal medicine physician during the first 24 hours of patient admission to the unit with a presumptive cardiopulmonary diagnosis. The University of Melbourne iHeartScan, iLungScan and 2-point venous compression protocols are followed to identify left and right ventricular function, significant valvular heart disease, pericardial and pleural effusion, consolidation, pulmonary edema, pneumothorax and proximal deep venous thrombosis. Patient management is not commanded by the protocol and is at the discretion of the treating team. A total of 250 patients will be recruited at one tertiary hospital. Participants are randomized to receive POCUS or no POCUS. The primary outcome measured will be hospital length of stay. Secondary outcomes include the change in diagnosis and management, 30-day hospital readmission and health care costs. Discussion This study will evaluate the clinical impact of multi-organ POCUS in internal medicine patients admitted with cardiopulmonary diagnosis on the hospital length of stay. Recruitment of participants has commenced in September of 2018 and is estimated to be completed by March 2020.

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Utility of Point of Care Ultrasound in Humanitarian Assistance Missions

Military Medicine ◽

10.1093/milmed/usaa348 ◽

2021 ◽

Vol 186 (Supplement_1) ◽

pp. 789-794

Author(s):

John F Sullivan ◽

Marinha do Brasil ◽

John W Roman ◽

Edmund A Milder ◽

E Carter ◽

...

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Patient Management ◽

Point Of Care ◽

Humanitarian Assistance ◽

Point Of Care Ultrasound ◽

Diagnostic Modality ◽

Madeira River ◽

The Usa ◽

Relief Efforts

ABSTRACT Introduction Point of care ultrasound (POCUS) is increasingly used in primary care in the USA and has been shown to provide significant benefit to care in deployed military settings and during disaster relief efforts. It is less studied as a tool during humanitarian assistance missions. We sought to determine the utility of POCUS in a humanitarian assistance setting during the February 2019 joint U.S.–Brazilian hospital assistance mission aboard the Hospitalar Assistance Ship Carlos Chagas along the Madeira River in the Brazilian Amazon. Materials and Methods Point of care ultrasound was offered as a diagnostic modality to primary care physicians during the course of a month-long mission. A handheld IVIZ ultrasound machine was loaned for use during this mission by Sonosite. A P21v phased array (5-1 MHz) or an L38v linear (10-5 MHz) transducer was used for scanning. Requests for POCUS examinations, their findings, and changes in patient management were recorded. Results Point of care ultrasound examinations were requested and performed in 24 of 814 (3%) outpatient primary care visits. Ten of these studies (42% of POCUS examinations, 1.2% of all patient visits) directed patient management decisions, in each case preventing unnecessary referral. Conclusions In this austere setting, POCUS proved to be an inexpensive, effective tool at preventing unnecessary referrals. Future medical humanitarian assistance missions may likewise find POCUS to be a primary care force-multiplier.

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

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1093/trstmh/traa137 ◽

2020 ◽

Author(s):

Fumbani Limani ◽

Dingase Dula ◽

Alexander J Keeley ◽

Elizabeth Joekes ◽

Tamara Phiri ◽

...

Keyword(s):

Patient Management ◽

Ultrasound Examination ◽

Point Of Care ◽

Training Programme ◽

Radiology Department ◽

Point Of Care Ultrasound ◽

Central Hospital ◽

Medical Inpatients ◽

Record Review ◽

Queen Elizabeth Central Hospital

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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Point-of-Care Ultrasound Use by EMS Providers in Out-of-Hospital Cardiac Arrest

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21001357 ◽

2022 ◽

pp. 1-6

Author(s):

Michael A. Kreiser ◽

Brieanna Hill ◽

Dikchhya Karki ◽

Elke Wood ◽

Ryan Shelton ◽

...

Keyword(s):

Cardiac Arrest ◽

Patient Management ◽

Point Of Care ◽

Training Session ◽

Point Of Care Ultrasound ◽

Protocol Adherence ◽

Video Acquisition ◽

Advanced Airway ◽

Hospital Cardiac Arrest ◽

Adrenaline Administration

Abstract Aim: Paramedics received training in point-of-care ultrasound (POCUS) to assess for cardiac contractility during management of medical out-of-hospital cardiac arrest (OHCA). The primary outcome was the percentage of adequate POCUS video acquisition and accurate video interpretation during OHCA resuscitations. Secondary outcomes included POCUS impact on patient management and resuscitation protocol adherence. Methods: A prospective, observational cohort study of paramedics was performed following a four-hour training session, which included a didactic lecture and hands-on POCUS instruction. The Prehospital Echocardiogram in Cardiac Arrest (PECA) protocol was developed and integrated into the resuscitation algorithm for medical non-shockable OHCA. The ultrasound (US) images were reviewed by a single POCUS expert investigator to determine the adequacy of the POCUS video acquisition and accuracy of the video interpretation. Change in patient management and resuscitation protocol adherence data, including end-tidal carbon dioxide (EtCO2) monitoring following advanced airway placement, adrenaline administration, and compression pauses under ten seconds, were queried from the prehospital electronic health record (EHR). Results: Captured images were deemed adequate in 42/49 (85.7%) scans and paramedic interpretation of sonography was accurate in 43/49 (87.7%) scans. The POCUS results altered patient management in 14/49 (28.6%) cases. Paramedics adhered to EtCO2 monitoring in 36/36 (100.0%) patients with an advanced airway, adrenaline administration for 38/38 (100.0%) patients, and compression pauses under ten seconds for 36/38 (94.7%) patients. Conclusion: Paramedics were able to accurately obtain and interpret cardiac POCUS videos during medical OHCA while adhering to a resuscitation protocol. These findings suggest that POCUS can be effectively integrated into paramedic protocols for medical OHCA.

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Point-of-care ultrasound (POCUS) in a remote area of Sierra Leone: impact on patient management and training program for community health officers

Journal of Ultrasound ◽

10.1007/s40477-019-00426-w ◽

2020 ◽

Vol 23 (4) ◽

pp. 521-527 ◽

Cited By ~ 1

Author(s):

Vittorio Sabatino ◽

Maria Rosaria Caramia ◽

Antonietta Curatola ◽

Francesca Vassallo ◽

Andrea Deidda ◽

...

Keyword(s):

Community Health ◽

Training Program ◽

Sierra Leone ◽

Patient Management ◽

Point Of Care ◽

Remote Area ◽

Point Of Care Ultrasound ◽

And Training

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Scope of point-of-care ultrasound practice in rural New Zealand

Journal of Primary Health Care ◽

10.1071/hc18031 ◽

2018 ◽

Vol 10 (3) ◽

pp. 224 ◽

Cited By ~ 4

Author(s):

Garry Nixon ◽

Kati Blattner ◽

Jillian Muirhead ◽

Wendy Finnie ◽

Ross Lawrenson ◽

...

Keyword(s):

Quality Assurance ◽

New Zealand ◽

Inferior Vena ◽

Point Of Care ◽

Venous Pressure ◽

Vena Cava ◽

Point Of Care Ultrasound ◽

Diagnostic Certainty ◽

Hospital Doctors ◽

Set Up

ABSTRACT INTRODUCTION Point-of-care ultrasound (POCUS) is an increasingly common adjunct to the clinical assessment of patients in rural New Zealand. AIM To describe the scope of POCUS being practiced by rural generalist hospital doctors and gain insights, from their perspective, into its effect. METHODS This was a mixed-methods descriptive study. Main outcome measures were type and frequency of POCUS being undertaken. A questionnaire was given to POCUS-active rural hospital doctors to survey the effect of POCUS on clinical practice and assess issues of quality assurance. RESULTS The most commonly performed scans were: cardiac (18%) and volume scans (inferior vena cava and jugular venous pressure) (14%), followed by gallbladder (13%), kidney (11%), Focused Assessment with Sonography in Trauma (FAST) (7%), bladder (6%), leg veins (6%) and lungs (5%). There was large variation in frequency of scan types between the study hospitals that could not be accounted for by differences in training. The participating doctors considered that POCUS had a positive and significant effect on their practice, largely by adding to diagnostic certainty. Challenges identified included maintenance of POCUS skills, lack of systems for POCUS set-up and the absence of quality assurance for POCUS in rural hospitals. DISCUSSION Rural generalists consider the broad scope of POCUS they practise to be an important but challenging skill set. Clinical governance, including an agreed scope and standards, may increase the benefits and improve the safety of rural POCUS.

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