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Can App-Based Point-of-Care Ultrasound Improve Emergency Care? Absolutely.

 

 

Evidence of the benefits of point-of-care ultrasound (POCUS) continues to grow. 1 POCUS gives emergency physicians (EPs) access to real-time clinical information that can help reduce time to diagnosis. 2 Time is always a precious resource in the emergency department (ED), and it’s even more precious when a patient is “coding” or the ED is hit with a flood of patients who all require immediate attention. The speed and accuracy of bedside ultrasound in triage and diagnosis is why virtually all disaster preparedness plans recommend it as the first course of action. 3
In addition, POCUS facilitates faster patient throughput. The reduction in wait times for patients can be significant. For example, a study published in the World Journal of Emergency Medicine compared the time to overall length of stay (LOS) for patients who required pelvic imaging as part of their emergency department assessment. In the study, patients who underwent ultrasound in the emergency department versus the radiology department ultrasound (RDUS) had a significant decrease in time to ultrasound and ED LOS. Patients randomized to the RDUS arm experienced a 120 minute longer ED length of stay.4

Barriers to Adoption

 

Despite the many benefits of POCUS, a study published in the Western Journal of Emergency Medicine highlighted the utilization gap between academic emergency departments and other emergency settings. The study surveyed ED directors in five states (Arkansas, Hawaii, Minnesota, Vermont and Wyoming) in 2010. The survey was able to determine the proportion of emergency physicians using POCUS and identify barriers to POCUS use in these states.

 

The survey demonstrated that availability of POCUS varied by state from 34% to 85%. Availability was associated with higher ED visit volume and percent of emergency physicians who are board certified/board eligible in emergency medicine.

 

The study’s authors identified three main barriers to the use of bedside ultrasound:

1.       Lack of training (70 percent)

2.       Expense (39 percent)

3.       Limited (real or perceived) need for ultrasound (32 percent)

 

Notably, of the EPs who said that they weren’t using POCUS because of limited need, the authors predicted that many would change their opinions if they were given more training. A substantial number of the EDs in the study also reported that POC ultrasound was not available due to high cost, demonstrating a market need for lower-cost devices.

 

Given the triple barriers of training, cost, and perceived limited need for bedside ultrasound, what can be done to increase its use? Ultimately, the study’s authors recommended leveraging “recent educational and technical advancements” to get POCUS into the hands of more doctors. The authors noted that the widespread use of asynchronous learning platforms has made it easier than ever to learn POCUS at little (if any) cost. Education-oriented websites such as American College of Emergency Physicians’ sonoguide.com continue to grow, as do free open-access medical education forums on websites, blogs, video logs, and other internet-based resources.

 

Bottom line: To increase the use of bedside ultrasound, doctors need ultrasound devices that are affordable, portable, and easy to learn. At the end of the day, increasing the use of bedside ultrasound in the ED will be a tandem effort. By combining access to training with more affordable ultrasound devices, widespread use of POCUS can become a reality.

New Solutions

 

Philips’ mobile app-based ultrasound technology, Lumify, offers a significant pathway to overcome the barriers facing wide adoption of POC ultrasound and strengthens the patient-physician connection. Exemplary of a new approach to medical technology which aims to bring the ease of use typically associated with consumer products to the realm of medicine, Philips Lumify combines transducers with compatible Android-based smart devices to create an ultrasound system that doctors can easily carry with them. The mobility, quality, simplicity, and flexibility of Lumify remove many of the barriers to POC ultrasound.

 

Pricing models, too, are changing. While traditional ultrasound equipment required large, up-front investments, now there are subscription-based ultrasound devices. As a result, devices like Philips Lumify, which will be showcased at the RSNA 2016 annual meeting, are more affordable than traditional ultrasound devices.

 

The use of POCUS has the potential to improve the connection and communication between physicians and patients, revealing an additional benefit to bedside ultrasound, the shared decision-making process. Shared decision-making is defined as a collaborative process that allows patients and healthcare providers to make decisions together when more than one reasonable alternative exists, accounting for the patient’s unique preferences and priorities and the best scientific evidence available.

 

Combined, these new approaches to ultrasound are opening new doors for the way physicians work. As we move toward a more connected and collaborative care model, patients in the ED receive faster, more personalized care. This has the potential to increase patient satisfaction and build trust, strengthening the patient/physician relationship.

References:

1. Sanders, J, Noble V, Raja A, Sullivan A, Camargo, C. Access to and use of point-of-care ultrasound in the emergency department. West J Emerg Med. 2015;16(5):747-752. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4644045.

2. “Emergency Ultrasound Guidelines.” American College of Emergency Physicians. https://www.acep.org/Clinical---Practice-Management/Ultrasound/.

3. Rosenfeld, J, et al. Is the Australian hospital system adequately prepared for terrorism? Med J Aust. 2005;183(11):567-570.  https://www.mja.com.au/journal/2005/183/11/australian-hospital-system-adequately-prepared-terrorism.

4. Wilson, S, et al. (2016). Point-of-care ultrasound versus radiology department pelvic ultrasound on emergency department length of stay. World J Emerg Med World Journal of Emergency Medicine, 7(3), 178. doi:10.5847/wjem.j.1920-8642.2016.03.003.

Randy Hamlin

Lead of Ultra Mobile business for Philips Ultrasound

Randy Hamlin is shaping a new market space in diagnostic ultrasound with a vision to connect clinicians and patients to ultrasound at the point of care. He has led both engineering and marketing organizations during his time at Philips and speaks regularly at innovation and industry events on the topic of creating disruptive solutions and services that can improve healthcare.

 

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