Handheld ultrasound to reduce requests for inappropriate echocardiogram (HURRIE)

Abstract

Background Handheld ultrasound could provide sufficient information to satisfy the clinical questions underlying ‘rarely appropriate’ echo requests, but there are limited data about its use as a gatekeeper to standard echocardiography. We sought to determine whether the use of handheld ultrasound could improve the appropriate use of echocardiography. Method A prospective study comparing handheld ultrasound strategy to standard echocardiography for studies deemed rarely appropriate, using a questionnaire based on appropriate use criteria was conducted across two hospitals, from October 2017 to April 2018. Results Groups undergoing Handheld ultrasound (n = 76, 58 (46.5–72.5) years, 53 males, 78% outpatients) and standard echocardiography (n = 72, 61 (49.0–71.5) years, 42 males, 76% outpatients) were comparable. There was a significant decrease in the time to scan from just over 1 month in standard group to a median of 12 days in handheld ultrasound group (P < 0.001). This difference was small for inpatients (from 1 day to a median of 10 min in handheld ultrasound, P = 0.014), but prominent in outpatients (from 1.5 months in the standard group to median of 2 weeks in the handheld ultrasound group, P < 0.001). There was no increase in the need for follow-up scan within 6 months and no significant differences in length of hospital stay for inpatients. Conclusion Handheld ultrasound can be an effective gatekeeper to standard echocardiography for requests deemed rarely appropriate, reducing time to echocardiography significantly and potentially decreasing the need for standard echocardiography by up to 20%.

Tablet-Based Limited Echocardiography to Reduce Sonographer Scan and Decontamination Time during the COVID-19 Pandemic

“…A prior study demonstrated the feasibility using handheld echocardiography as a screening tool for appropriateness. 11 The present study validates the use of a preliminary limited assessment with a handheld ultrasound device in inpatients meeting appropriate use criteria in the COVID-19 population.…”

Tecnologias utilizadas em cuidados críticos no combate a Covid-19: Revisão de escopo

“…Ademais seu uso reduz significantemente o tempo da realização do exame e diminui em até 20% a necessidade de uma ecocardiografia padrão (Haji et al, 2019). Em detrimento a estes achados, estudo (Ashrafian et al, 2004) realizado em UTI evidenciou que mais de trinta por cento de alterações cardíacas clinicamente relevantes não foram identificados por meio do ecocardiograma portátil, o que se atribui a menor definição da imagem deste equipamento (2D), em escala de cinza e doppler colorido.…”

Adapting the role of handheld echocardiography during the COVID-19 pandemic: A practical guide

“…HHE systems do not have the full functionality of established echocardiogram machines and are typically limited to two-dimensional (2D) and colour Doppler modalities. 4 There will be scenarios where the standard dataset cannot be achieved due to limited echo windows or in the setting of an acutely decompensating patient requiring an urgent intervention. In such cases, the key echocardiogram views will be dictated by the clinical circumstances.…”

“…able time. 4,5 It is important to note handheld ultrasound devices, due to their inherent limitations as outlined above, should only be used in clearly defined clinical settings. Education and training are also important considerations to ensure high clinical standards particularly for healthcare professionals who are RH strain describes increased RV afterload.…”

“…Ease of use and decontamination, together with its portability and low cost have highlighted its unique role in the current clinical era. 4,5 Handheld echocardiography (HHE) can be a valuable clinical tool in rapidly assessing the haemodynamic effects and guiding subsequent management of the ensuing COVID-19 clinical syndrome. 6,7 This article summarises the evolving role of HHE during a pandemic.…”