Point-of-care ultrasound streamlines care, reduces costs – and saves lives
One of the biggest daily challenges healthcare providers face is obtaining accurate diagnostic answers in a timely manner. Doctors spend years training in physical diagnosis, mastering techniques such as listening to hearts and lungs with a stethoscope, palpating the abdomen and examining painful joints.
THE PROBLEM
But even in the most expert hands, these traditional diagnostic methods lack the precision needed, says Dr. Stephen Erickson, a board-certified family physician who provides care at Jefferson Healthcare’s Townsend Clinic.
“To compensate for this, we rely heavily on expensive laboratory tests, time-consuming imaging studies and further interventions to confirm diagnoses,” he explained. “In fact, the cost of diagnostic testing in the US health care system is staggering. Annual spending on imaging procedures, including expensive X-rays, CTs and MRIs, has increased rapidly. more than 100 billion dollars annually about these procedures.
“In addition to the financial burden, these tests are often associated with long wait times, contributing to delays in patient care, unnecessary hospitalizations and increased patient anxiety,” he continued. “These inefficiencies strain healthcare resources and impact clinical workflows, making timely and accurate decision-making even more difficult to achieve.”
Point-of-care ultrasound, or POCUS, helps doctors overcome many of these challenges, he argued. With the ability to visualize the body at the point of care using a pocket-sized ultrasound, physicians 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 several cases,” Erickson noted. “For example, for much of my career, suspected pneumonia automatically led to ordering a chest X-ray. Today, we know from multiple studies that lung ultrasound not only provides faster and cheaper results, but also more sensitive for detecting pneumonia.
“POCUS is transforming the diagnostic landscape, allowing physicians to make faster, more informed decisions and ultimately improve patient outcomes,” he added.
PROPOSAL
POCUS technology proposes to solve the problem of diagnostic delays and inaccuracies in many clinical settings, with a focus on bringing real-time imaging capabilities directly to the bedside.
“Traditionally, medical imaging was limited to specialized radiology departments, with physicians often relying on bulky, expensive equipment such as ultrasound charts, CT scans, MRIs or X-rays to get a comprehensive view of a patient’s internal structures,” Erickson said. “This process, while still very valuable in some cases, can cause significant delays, especially in time-sensitive emergencies or in rural settings where access to radiology is often limited.
“POCUS technology changes this by decentralizing imaging and making it accessible to physicians outside the radiology department,” he continued. “The portable nature of POCUS devices allows physicians to perform targeted, immediate scans at the patient’s side, without having to wait for specialized equipment or personnel.”
POCUS has the ability to provide immediate answers to critical, yes or no, diagnostic questions. For example, in situations where the primary concern is whether a patient is experiencing 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 site, he added.
“Additionally, new devices that have come to market in the past five years have even made it possible to image the entire body with a single, all-in-one probe,” Erickson noted. “By putting this technology in the hands of emergency physicians, nurses and physician assistants, POCUS provided a streamlined solution to reduce reliance on expensive and time-consuming imaging tests.
“It enabled medical professionals to quickly and confidently identify urgent problems – such as pleural effusions, pneumothorax or cardiac tamponade – allowing immediate treatment decisions to be made,” he continued. “This real-time diagnostic tool was intended to alleviate the problem by providing a faster and more immediate method of assessment, especially in settings where delays in diagnosis could result in poor patient outcomes or when rapid decisions were needed for effective triage. “
POCUS technology has enabled healthcare providers to bypass traditional bottlenecks in diagnostic processes while still delivering accurate and life-saving information, he added.
“By doing so, it promised to improve workflow efficiency, reduce wait times and potentially lower healthcare costs, while improving the quality of patient care,” he said.
MEETING THE CHALLENGE
At Jefferson Healthcare, the integration of POCUS technology began with its deployment in the emergency department, where physicians urgently needed rapid diagnostic capabilities at any time of day.
“Initially, ER physicians used POCUS to quickly assess critical conditions such as internal bleeding, lung problems and heart function, which helped streamline decision-making and guide immediate treatments,” Erickson explains. “The benefits of POCUS in delivering fast, reliable diagnostics without the delays of traditional imaging quickly became apparent, prompting other departments to request access to their own devices.
“Over time, there is more and more evidence about it the usefulness of POCUS has increased,” he continued. “More and more specialties have asked for their own POCUS device in their department. To name a few common use cases, in the anesthesia department, POCUS is used to improve the accuracy of nerve blocks and to assess patients preoperatively for conditions such as gastric aspiration risk.”
Obstetricians can use POCUS to monitor fetal well-being and positioning, improving both routine assessments and responses to emergent situations. Similarly, in orthopedics, rheumatology and sports medicine, POCUS can be a tool to guide more precise joint injections and to diagnose tendon or ligament injuries with greater precision.
In primary care, physicians use POCUS not only for diagnostics, but also as a patient education tool, showing real-time imaging to help patients understand their diagnoses.
“Although POCUS began as a standalone tool, it was eventually integrated with electronic medical records and image databases, allowing physicians to seamlessly document and share findings with other providers,” Erickson said. “At our facility, we have deployed Butterfly iQ portable POCUS devices in every primary care clinic, our infusion center and our pre-anesthesia department.
“We also have ultrasound machines on carts from multiple manufacturers in various locations throughout our hospital,” he continued. “All POCUS machines are connected with DICOM links to our Epic EHR and PACS servers to enable more optimized workflow and image accessibility across the care continuum. We also use Butterfly Compass workflow software for QA review of images sourced of every POCUS device in the entire world organization.”
RESULTS
The POCUS technology has proven to be a cost-effective diagnostic tool that significantly improves the physical exam, Erickson said.
“One of the challenges in quantifying the success of deploying POCUS is that it is very difficult to measure the money not wasted on excessive testing, or the patients who did not end up in hospital because their disease was recognized more quickly . ” he noted. “That said, I think any doctor who uses POCUS can tell you about cases where this has occurred.”
Erickson gave a few examples of such cases that have occurred in recent months.
“A patient who came to my office late in the afternoon with symptoms that resembled a blood clot in a leg vein,” he explained. “This is potentially dangerous because an untreated blood clot can break off, travel to the heart and cause a fatal embolism.
“Traditionally, this patient would be sent to the emergency room because I can’t get a venous ultrasound exam quickly enough on an outpatient basis,” he continued. “By means of By taking a POCUS exam for less than $50, I was able to get my answer, start proper treatment, and avoid a $2,000 emergency room bill.”
Another example: inserting intrauterine contraceptives can be unpredictably painful for some women.
“A quick POCUS scan before IUD placement can detect anatomic variations that are likely to result in pain or even dangerous complications such as uterine perforation,” Erickson said. “And after IUD placement, women are traditionally asked to return in six weeks for a second pelvic exam to confirm that the IUD remains in the correct location.
“It has brought great patient satisfaction to instead perform a quick ultrasound scan to more accurately confirm the position of the IUD without the need for the patient to undress,” he added.
And a final example: an elderly patient who could not speak because of a previous stroke was brought in by his wife because he had “simply not acted properly.”
“My physical examination revealed little useful information as to why,” Erickson explained. “It was difficult to know whether he needed extensive testing or reassurance. However, POCUS quickly revealed new, severe systolic heart failure. He was sent straight to the emergency department, where further tests confirmed a massive, silent heart attack.
“I shudder to think about the outcome of that case if I hadn’t had my POCUS device,” he said.
ADVICE FOR OTHERS
“My advice for healthcare organizations considering adopting POCUS technology is to start setting up the IT system interfaces early so they are ready for expanded POCUS use in the future,” Erickson advised. “Many departments ultimately want POCUS, and each has their own ideas about what is best for them.
“But an IT or biomedical department doesn’t want to be saddled with managing multiple systems that can’t work together,” he continued. “Ensure stakeholders agree on two or three preferred ultrasound equipment vendors and take the time to set up the DICOM links to your EHR and PACS. Provide standardized training in these workflows for each new user to ensure that the proper documentation standards are followed.”
These things take time, but it becomes increasingly difficult to implement them across departments as non-standardized practices proliferate, he concluded.
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