Actual use of pocket-sized ultrasound devices for cardiovascular examination by trained physicians during a hospitalist rotation

Abstract

BackgroundIn actual clinical practice as opposed to published studies, the application of bedside ultrasound requires a perception of need, confidence in one's skills, and convenience.ObjectiveAs the frequency of ultrasound usage is evidence to its perceived value in patient care, we observed the pattern of autonomous use of a pocket-sized device (PSD) by ultrasound-trained residents during a night hospitalist rotation.MethodsConsecutive internal medicine residents (n=24), trained in a cardiac limited ultrasound examination (CLUE) as a mandatory part of their curriculum, were sampled on their PSD use after their admitting nights, regarding perceived necessity, deterring factors, detected abnormalities, and imaging difficulties. A detailed analysis was performed with one resident who used a PSD on every admission to compare the proportion of abnormal CLUEs and utility in patients with and without a perceived need.ResultsResidents admitted 542 patients (mean age: 55±17 years, range: 17–95 years) during 101 shifts and performed CLUE on 230 patients (42%, range: 17–85%). Residents elected not to scan 312 (58%) patients due to 1) lack of perceived necessity (231, 74%), 2) time constraints (44, 14%), and 3) patient barriers (37, 12%). In the detailed analysis (n=71), the resident felt CLUE was necessary in 32 (45%) patients versus unnecessary in 39 (55%) patients, with abnormality rates of 50% versus 20.5% (p=0.01) and utility rates of 28.1% versus 15.4% (p=0.25), respectively.ConclusionWhen unbiased residents acting as hospitalists are provided with a PSD to augment initial cardiac examination, usage is frequent and suggests clinical value in hospital medicine.

The Use of Handheld Ultrasound Devices – An EFSUMB Position Paper

“…Based on the technical performance of units at that time, the listed indications were: complement to clinical examination, screening tool in the emergency room or ambulance, initial evaluation in outreach clinics, triage tool for determining who should undergo fully comprehensive echocardiogram and teaching tool [33]. One study evaluated the spontaneous use (not part of a clinical trial) of HHUSDs by non-specialist hospital residents who had undergone appropriate training [34]. The use of an HHUSD by 24 residents admitting 542 patients overnight was retrospectively analyzed.…”

Prognostic Implications of a Point‐of‐Care Ultrasound Examination on Hospital Ward Admission

“…Residents performed CLUE on patients when warranted for clinical decision making. In a separate study, this indication resulted in an average use of 42% in all serial admissions but with a large range (17%–85%) between residents. This variability reflects the interplay of multiple factors and barriers, including diagnostic uncertainty at the time of presentation, self‐confidence by the physician in his or her own US skills, time pressure, and patient compliance.…”

“…Carrying 1 of 2 pocket‐sized devices (Vscan Duoprobe; GE Healthcare, Wauwatosa, WI; or Lumify; Philips Healthcare, Andover, MA), the residents had been instructed to perform a CLUE at their own discretion on patients to assist in diagnosis during the admission physical examination, as described in a previous study . A cardiologist, an expert in CLUE, served as part‐time teaching faculty for the night float rotation, along with a faculty internist.…”

Atrial Hemangioma: A Case Report and Review of the Literature

“…19) By bedside cardiac ultrasound, we can quickly assess cardiac structural and functional abnormalities and make a diagnosis as early as possible to determine the atrial tumor. 20) Routine two-dimensional echocardiography can determine the size, location, activity, and compression of the tumor. It most commonly appears as “homogeneous solid tumor signs” in two-dimensional echocardiography.…”