One of the biggest challenges healthcare providers face every day is obtaining accurate diagnostic results in a timely manner. Clinicians spend years training in physical examination, mastering techniques such as listening to the heart and lungs with a stethoscope, palpating the abdomen, and examining painful joints.
problem
But even with the help of the most experts, these traditional diagnostic methods lack the necessary accuracy, says Steven Erickson, a board-certified family medicine physician who practices at Jefferson Healthcare's Townsend Clinic. says the doctor.
“To compensate for this, we rely heavily on expensive laboratory tests, time-consuming imaging tests, and further interventions to confirm the diagnosis,” he explained. “In fact, the cost of diagnostic testing in the U.S. health care system is staggering. Annual spending on expensive X-ray, CT, MRI, and other imaging procedures is rapidly increasing. I am. More than $100 billion is spent annually on these procedures.
“In addition to the financial burden, these tests often involve long wait times, leading to delays in patient care, unnecessary hospitalizations, and increased patient anxiety,” he continued. “This inefficiency strains healthcare resources, impacts clinical workflow, and makes timely and accurate decision-making more difficult to achieve.”
Point-of-care ultrasound (POCUS) is helping clinicians overcome many of these challenges, he argued. By using pocket-sized ultrasound to visualize the body at the point of care, clinicians can streamline the diagnostic process, improve accuracy and save time and money, he said.
“In fact, POCUS has been shown to outperform traditional diagnostic methods in some cases,” Erickson said. “For most of my career, for example, suspected pneumonia automatically led to a request for a chest x-ray. Today, lung ultrasounds provide faster and cheaper results. Multiple research studies have shown that it can provide more effective results. Detection of pneumonia becomes more sensitive.
“POCUS will transform the diagnostic landscape, enabling clinicians to make faster and more informed decisions, ultimately improving patient outcomes,” he added.
suggestion
POCUS technology proposes to solve the problems of diagnostic delays and inaccuracies in many clinical settings, focusing on bringing real-time image processing capabilities directly to the bedside.
“Traditionally, medical imaging has been limited to specialized radiology departments, where doctors rely on large and expensive instruments such as ultrasound cards, CT scans, MRIs, and X-rays to obtain a comprehensive view of a patient's internal structures. We relied a lot on equipment,” Erickson said. “While this process can still be of great value in some cases, it can result in significant delays, especially in time-sensitive emergencies and in rural areas where access to radiology is often limited.
“POCUS technology changes this by decentralizing imaging and making images accessible to clinicians outside of radiology,” he continued. “Because POCUS devices are handheld, clinicians can perform targeted, immediate scans at the patient's side without waiting for specialized equipment or personnel.”
POCUS has the ability to provide immediate answers to important diagnostic questions (“yes” or “no”). For example, in a situation where the primary concern is whether the patient is suffering from internal bleeding, A detailed MRI or CT scan may not be needed immediately. POCUS provides a faster way to detect or rule out such conditions on the spot, it added.
“Additionally, new devices that have appeared on the market in the past five years have also made it possible to image the entire body with a single all-in-one probe,” Erickson said. “By putting this technology into the hands of emergency room physicians, nurses, and physician assistants, POCUS has provided a streamlined solution that reduces reliance on costly and time-consuming imaging tests.
“This allows medical professionals to quickly and confidently identify urgent problems such as pleural effusions, pneumothorax and cardiac tamponade, allowing immediate treatment decisions to be made,” he continued. “This real-time diagnostic tool provides a more rapid and direct method of assessment, especially in settings where delays in diagnosis can worsen patient outcomes or where rapid decisions are needed for effective triage. That should have alleviated the problem.”
POCUS technology now allows healthcare providers to avoid traditional bottlenecks in the diagnostic process while providing accurate and life-saving information, he added.
“Doing so promises to increase workflow efficiency, reduce wait times, and potentially reduce healthcare costs, while improving the quality of patient care,” he said.
deal with challenges
At Jefferson Healthcare, the integration of POCUS technology began with its introduction to the emergency department, where physicians urgently need rapid diagnostic capabilities at any time.
“Initially, ER doctors used POCUS to quickly assess critical conditions such as internal bleeding, lung problems, and heart function. This streamlined decision-making and directed immediate treatment. ,” Erickson explained. “The benefits of POCUS in providing fast, reliable diagnosis without the delays of traditional image processing quickly became apparent, and other departments began requesting access to their own devices.
“Over time, a growing body of evidence has emerged regarding: “POCUS is becoming increasingly useful,” he continued. “As a result, more and more specialties are looking to install their own POCUS devices in their departments. Anesthesiology, to improve the accuracy of nerve blocks, to name a few common use cases. POCUS is used to assess patients preoperatively for conditions such as risk of gastric aspiration.
Obstetricians can use POCUS to monitor fetal health and position, enhancing both routine assessments and emergency response. Similarly, in orthopedics, rheumatology, and sports medicine, POCUS can be a tool to guide more precise joint injections and more accurately diagnose tendon and ligament injuries.
In primary care, physicians use POCUS not only for diagnosis but also as a patient education tool, displaying real-time images to help patients understand the diagnosis.
“POCUS started as a standalone tool, but eventually integrated with electronic medical records and image databases, allowing clinicians to seamlessly document and share findings with other providers,” Erickson said. says. “At our facility, we have Butterfly iQ handheld POCUS devices in each primary care clinic, infusion center, and pre-anesthesia unit.
“We also have cart-based ultrasound machines from multiple manufacturers in various locations throughout our hospital,” he continued. “All POCUS machines are networked with DICOM links to Epic EHR and PACS servers, allowing for more optimal workflow and access to images across the continuum of care. My organization uses Butterfly Compass workflow software for QA review of images from POCUS devices.
result
POCUS technology has proven to be a cost-effective diagnostic tool that greatly enhances physical examinations, Erickson reported.
“One of the challenges in trying to quantify the success of utilizing POCUS is the cost that was not wasted on over-testing, and the number of patients who ended up not being admitted because their disease was recognized earlier.” “It's very difficult to measure,” he pointed out. “That being said, I'm sure any clinician who uses POCUS can tell you about cases where this has happened.”
Erickson cited several examples of such incidents that have occurred in the past few months.
“A patient came to my office in the late afternoon complaining of symptoms suggestive of a blood clot in a leg vein,” he explained. “This is potentially dangerous because an untreated blood clot can break off and reach the heart, causing a fatal embolism.
“Traditionally, this patient would be sent to the emergency room because outpatient settings would not schedule a venous ultrasound early enough,” he continued. “by For less than $50, a POCUS test gave me answers, started appropriate treatment, and avoided a $2,000 emergency room bill. ”
Another example: Intrauterine device placement can be unexpectedly painful for some women.
“A simple POCUS scan before inserting an IUD can screen for anatomical changes that can cause pain or dangerous complications such as uterine perforation,” Erickson said. . “And after having an IUD fitted, women are traditionally asked to have a second pelvic exam six weeks later to make sure the IUD remains in place.
“Patients found great satisfaction in performing a quick ultrasound instead to more accurately locate the IUD without requiring the patient to undress,” he added.
And here's the final example. An elderly patient who is unable to speak due to a previous stroke is brought in by his spouse because he “just wasn't acting right.”
“My physical exam didn't provide much useful information as to why,” Erickson explained. “It was difficult to determine whether he needed extensive testing or reassurance. However, POCUS quickly showed new severe systolic heart failure. He was immediately sent to the emergency department where further tests confirmed a massive silent heart attack.
“I shudder to think of the outcome of that incident if I didn't have the POCUS device,” he said.
advice to others
“My advice to healthcare organizations considering implementing POCUS technology is to start early setting up IT system interfaces to prepare for expanded use of POCUS in the future,” Erickson advised. “Many departments may ultimately need POCUS, and each may have their own ideas about what is best for them.
“But IT and biomedical departments don't want to be burdened with managing multiple systems that don't work together,” he continued. “Get stakeholders to agree on two or three preferred ultrasound equipment vendors and take the time to set up DICOM links to EHRs and PACS. Ensure proper documentation standards are followed. Set up standardized training on these workflows for each new user.
These things take time, he concluded, but the longer non-standardized practices prevail, the harder it becomes to implement them across sectors.
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