From the Guidelines
Yes, Emergency Department (ED) Point Of Care (POC) ultrasound increases patient throughput.
Key Points
- POCUS can improve the correctness of diagnosis in patients with acute dyspnea, as it allows for real-time bedside diagnosis and management 1.
- The use of POCUS in addition to the standard diagnostic pathway can lead to statistically significantly more correct diagnoses in patients with dyspnea than the standard diagnostic pathway alone 1.
- POCUS can also improve the sensitivities of standard diagnostic pathways to detect congestive heart failure, pneumonia, pulmonary embolism, pleural effusion, or pneumothorax, and increase specificities in most cases 1.
- The American College of Physicians suggests that clinicians may use POCUS in addition to the standard diagnostic pathway when there is diagnostic uncertainty in patients with acute dyspnea in emergency department or inpatient settings, with a conditional recommendation and low-certainty evidence 1.
Benefits of POCUS
- Improved diagnostic performance compared to standard clinical examinations
- Facilitates timely and appropriate management of critically ill patients
- Alleviates the need for ultrasonography or other imaging tests
- Can be performed without the hazard of ionizing radiation exposure and does not require the transfer of patients to radiology suites
Limitations of Current Evidence
- Most studies assessed diagnostic test accuracy, which has limited utility for clinical decision making
- Studies rarely reported on the proportion of indeterminate sonography results, and no evidence is available on adverse health outcomes of false-positive or false-negative POCUS results 1
From the Research
Emergency Department Point Of Care Ultrasound
- The use of point-of-care ultrasound (POCUS) in the emergency department (ED) has been shown to have various benefits, including increasing patient throughput 2, 3.
- POCUS can be used to diagnose a wide range of clinical conditions accurately, including appendicitis, hydronephrosis, and pleural effusion 2.
- The use of POCUS can also guide peripheral venous access and central venous catheter insertion, increasing the overall success rate and reducing the number of skin punctures 2.
- A study found that POCUS was felt to have the greatest potential in identifying missed diagnoses and decreasing the time to diagnosis, especially in patients with cardiopulmonary chief complaints and abnormal vital signs 4.
Point Of Care Ultrasound and Patient Throughput
- While there is evidence that POCUS can increase patient throughput, the studies provided do not directly address this question 2, 3.
- However, it can be inferred that the use of POCUS can lead to faster diagnosis and treatment, which can in turn increase patient throughput 2, 4.
- A study on the future of point-of-care testing in emergency departments found that point-of-care testing technology can provide clinicians with accurate and reliable results with at least a 50% reduction in turnaround time, which can help increase patient throughput 3.
Limitations and Future Directions
- The studies provided have some limitations, including the retrospective nature of some of the studies and the lack of direct evidence on the impact of POCUS on patient throughput 2, 4, 3.
- Further studies are needed to fully understand the benefits and limitations of POCUS in the ED and its impact on patient throughput 2, 4, 3, 5, 6.