Point-of-care ultrasound devices could help doctors make better diagnoses when hospitalized patients show dyspnea or shortness of breath, leading to shorter hospital stays and lower hospitalization costs. Results from a 200-patient study, published in JAMA Network Open, showed that using a portable ultrasound device to diagnose patients admitted with shortness of breath shortened their average length of stay by 3.6 days, reducing hospitalization costs by more than $750,000.
“The study clearly shows that ultrasound is the superior diagnostic technology, even for long-time stethoscope users who get a few hours of ultrasound training,” said Partho P. Sengupta, MD, professor of cardiology at Rutgers Robert Wood Johnson Medical School and chief of the division of cardiovascular diseases & hypertension at Rutgers Robert Wood Johnson University Hospital.
Dyspnea, also known as shortness of breath, is a very common symptom affecting nearly one in every 10 hospitalized patients. This symptom can be linked to a wide range of conditions, and is often associated with poorer clinical outcomes, frequent readmissions and higher mortality rates. Initial evaluations of patients with dyspnea are typically performed with stethoscopes at the point of care, which can then be followed up by X-ray imaging when necessary.
“Ultrasound gives you more information, and more concrete information, about what’s going on,” said Sengupta. “When clinicians can see fluid in the lungs, a failing heart or a stiff inferior vena cava in minutes, they can target therapy sooner or rule out a cardiopulmonary cause and look elsewhere.”
As part of the study, hospitalists at the Rutgers Robert Wood Johnson University Hospital received ultrasound training to perform and interpret exams using a portable ultrasound device that attaches to smartphones or tablets to visualize results and capture images. Expert sonographers were available to assist them with the procedure, as well as cardiologists to remotely support with the interpretation of results.
A total of 208 patients participated in the study, of which 101 were diagnosed using the ultrasound device and 107 using conventional stethoscope evaluations. Results showed that ultrasound diagnoses altered medical decisions in 35% of patients and reduced the length of hospital stays by 30.3%, from an average of 11.9 to 8.3 days.
Over the course of the six months where the study took place, ultrasound diagnoses resulted in a total reduction of 246 bed days, saving the hospital approximately $3,000 per hospital bed and per day for a total of over $750,000.
Despite the clear benefits of using the ultrasound device at point of care, the study found that only 20% of evaluations were performed independently by hospitalists, while the remaining were conducted by sonographers. This highlighted some major barriers to the adoption of point-of-care ultrasound by hospitalists, including time restrictions and a lack of incentives to incorporate new techniques as a standard of care.
“This is consistent with what we observe in day-to-day clinical practice,” said Sengupta. “Although the ultrasound probe fits in your pocket and attaches to the back of a smartphone, its use in clinical settings remains inconsistent.”
Since not every hospital can have sonographers and cardiologists available to assist with point-of-care evaluations, future studies will evaluate the use of tailored education and sustainable support systems that make the long-term integration of ultrasound into routine practice.
“Our data suggest the need for further education and training, development of incentives, and continued collaboration between sonographers and expert physicians as potential strategies for implementing the use of point-of-care ultrasonography in hospital medicine,” concluded the researchers.
