From the 2018 HVPAA National Conference
Jamie Felzer (Scripps Clinic), Chris Plaman (Scripps Clinic), Neil Kalra (Scripps Clinic), Laura Nicholson (Scripps Clinic)
Background
Gathering complete and accurate information during an initial patient encounter is critical for an informed differential diagnosis and subsequent treatment. Point of care ultrasound can be used to aide in bedside examination of a patient.
Objectives
To determine whether the implementation of physician-performed, smart device ultrasound (US) using a portable unit, Philips Lumify, at the patient’s bedside will reduce the number of radiology tests ordered, in particular the number of interventional radiology (IR) procedures requested, and whether its use decreases time to diagnosis and to patient intervention/treatment.
Methods
Scripps Green hospitalists and internal medicine residents received 1-hour training sessions using Philips Lumify smart device portable US, made available for use September, 2016 to July, 2017. The ultrasounds were available at all hours of the day for physicians to use to augment their physical examination. Physicians were asked to complete an online survey for each use of the device regarding the reason it was used, associated user satisfaction, and (when possible) patient satisfaction.
Results
Twenty-two unique users completed 68 surveys: 63% of the time, the bedside US was used to augment physical examination, most commonly to evaluate volume status with inferior vena cava imaging; 37% of the time it was used in association with a bedside procedure, most commonly paracentesis but also thoracentesis and lumbar puncture. For 84% of uses, physicians reported that it shortened time to diagnosis; 81% reported shortened time to treatment as a result. Regarding referral to IR, 34% reported ability to forego a referral by using bedside ultrasound; in 15% a referral was still necessary, and for 51% this question was not applicable. In 41%, a specific diagnostic test was not ordered due to results of the bedside ultrasound. Eighty-seven percent of physicians reported being “very satisfied” and 9% were “somewhat satisfied,” with 1% “neutral” and 3% “somewhat dissatisfied.” For 34 of 68 surveys, patients were able to respond: no patient found the examination uncomfortable and 88% reported a better understanding of their illness as a result of the bedside US use.
Conclusion
Hospitalists and internal medicine residents utilized portable US for physical examination and bedside procedures, reporting shortened time to diagnosis and treatment, which should result in improved patient outcomes and potentially shorter hospital stays. They also reported the ability to forego IR referral and additional diagnostic testing, which will produce cost of care savings and additional time saved.
Implications for the Patient
High patient comfort and increased understanding of disease should increase patient satisfaction. These findings argue for consistent use of high quality, portable bedside US on inpatient internal medicine services to improve quality of care and reduce cost.
