Economic analysis of bedside ultrasonography (US) implementation in an Internal Medicine department

Abstract

The economic crisis, the growing healthcare demand, and Defensive Medicine wastefulness, strongly recommend the restructuring of the entire medical network. New health technology, such as bedside ultrasonography, might successfully integrate the clinical approach optimizing the use of limited resources, especially in a person-oriented vision of medicine. Bedside ultrasonography is a safe and reliable technique, with worldwide expanding employment in various clinical settings, being considered as ''the stethoscope of the 21st century''. However, at present, bedside ultrasonography lacks economic analysis. We performed a CostBenefit Analysis ''ex ante'', with a break-even point computing, of bedside ultrasonography implementation in an Internal Medicine department in the mid-term. Number and kind estimation of bedside ultrasonographic studies were obtained by a retrospective study, whose data results were applied to the next 3-year period (foresight study). All 1980 foreseen bedside examinations, with prevailing multiorgan ultrasonographic studies, were considered to calculate direct and indirect costs, while specific and generic revenues were considered only after the first semester. Physician professional training, equipment purchase and working time represented the main fixed and variable cost items. DRG increase/appropriateness, hospitalization stay shortening and reduction of traditional ultrasonography examination requests mainly impacted on calculated revenues. The break-even point, i.e. the volume of activity at which revenues exactly equal total incurred costs, was calculated to be 734 US examinations, corresponding to € 81,998 and the time considered necessary to reach it resulting 406 days. Our economic analysis clearly shows that bedside ultrasonography implementation in clinical daily management of an Internal Medicine department can produce consistent savings, or economic profit according to managerial choices (i.e., considering public or private targets), other than evident medical benefits.

Barriers to point-of-care ultrasound use in rural emergency departments

“…Although financial data is lacking for the ED setting, Testa et al (2015) performed an economic analysis of bedside ultrasonography use in the internal medicine department that demonstrated overall cost savings after 734 ultrasound examinations had been performed, which occurred after 406 days of use. 31 Another possible solution is the implementation of telesonography, whereby a rural health care provider untrained in ultrasound is coached remotely in real-time by a trained physician to produce images and guide patient care. This was first piloted by the National Aeronautics and Space Agency (NASA) at the International Space Station before being tested terrestrially.…”

Evaluation of Trainee Competency with Point-of-Care Ultrasonography (POCUS): a Conceptual Framework and Review of Existing Assessments

“…Physicians can become proficient in POCUS with minimal training, and its use has been shown to improve diagnostic accuracy, reduce procedural complications, decrease inpatient length of stay, and improve patient satisfaction. [2][3][4][5][6][7] It can be applied in resource-limited settings, where restricted access to traditional radiological equipment can be a barrier to care. 8 POCUS has experienced increased usage given its positive impact on patient care.…”

CJEM Debate Series: #PoCUS–All physicians practicing emergency medicine should be competent in the use of point-of-care ultrasound

“…Several emergency PoCUS applications have been associated with decreased costs of care. Recent studies on the econometric impact of PoCUS on medical and critical care wards 12,13 show similarly impressive cost savings in the delivery of care. Of note, these economic benefits are borne out relatively quickly, typically within 1 year after the purchase of equipment and integration of PoCUS into routine care.…”