Point-of-Care Ultrasound Reduces Visit Time and Cost of Care for Infants with Developmental Dysplasia of the Hip

Abstract

Background Healthcare institutions and policymakers are searching for system-wide approaches to reduce costs while maintaining quality and improving patient outcomes. In most healthcare systems infants referred for the detecting or treating developmental dysplasia of the hip (DDH) are sent to a radiology department for sonographic evaluation. The total duration of visit and cost of visit are essential variables in any healthcare setting and affect both efficiency and “the bottom line”. By having the treating clinician perform point-of-care ultrasound (POCUS) for the detection and follow-up of patients with DDH, we hypothesize that there would be a significant reduction in the time spent on the visit and the cost incurred without compromising quality or patient satisfaction. To our knowledge, no prior study has examined the effect of incorporating POCUS on the duration and cost of the visit in patients with DDH. Purpose To determine if there was a difference in the duration of the visit for patients with DDH when POCUS was performed compared to when traditional “formal” sonography was performed. To determine if there was a difference in the cost of the visit for patients with DDH when POCUS was performed compared to when traditional “formal” sonography was performed. Methods Data for visits to a specialized outpatient office were collected over two years at a single-specialty orthopedic hospital, comparing the duration and cost of the visit between patient encounters for infants who had “formal” sonograms performed in the radiology suite to infants who underwent POCUS of the hip. In all, we included 532 patient encounters, 326 patients had POCUS performed, and 206 had a “formal” ultrasonographic evaluation performed. Of these, 140 were new evaluations and 392 were follow-up evaluations for treatment. Of the 140 new patients, 80 were in the POCUS group, and 60 were in the “formal” US group. Of the 392 follow-ups, 246 were in the POCUS group, and 146 were in the “formal” US group. Results The mean duration of the encounter for the POCUS group was 42 min (range 16–75 min), and for the “formal” US group, it was 92 min (range 36–163 min). This difference was statistically significant ( p = 0.002). The mean cost of the encounter for the POCUS group was $121.13, and for the “formal” US group, it was $339.38. This difference was statistically significant ( p = 0.002). Conclusion Ultimately, our study demonstrated a statistically significant reduction in the duration and cost of a patient encounter for infants with DDH when they undergo POCUS rather than “formal” sonographic evaluation.

Hip morphology on initial ultrasound predicts hip morphology at one year in developmental dysplasia of the hip

“…10 The authors' institution also recently performed a separate study which found that POCUS, compared to traditional sonography in the radiology department, led to significantly reduced visit time (42 vs 92 min, p = 0.002) and costs (US$121.13 vs US$339.38, p = 0.002). 19 While this study's findings could likely be extrapolated to traditional sonography, this study's findings add to the growing body of literature that POCUS, when performed by the treating orthopedic surgeon, is a safe, reliable, and costsaving tool in evaluating pediatric orthopedic patients, 12 especially those with DDH. 20 Treatment was started at a mean age of 22 days.…”

Acquiring the Skills to Perform Point of Care Ultrasound of the Infant Hip Through Simulation

“…Modern devices allow an immediate point-of-care access, which puts the information clinicians need during the visit, reducing costs and time. 11 Within the time course of our training, we have evolved our method of teaching. Initially, the structure was lecture-based and the next step was to practice on live neonates.…”

Single-sided magnetic resonance-based sensor for point-of-care evaluation of muscle

“…Point-of-care (POC) medical diagnostics are increasingly utilized in both inpatient and outpatient settings 1 , 2 . The ability to rapidly detect aneurysms, fluid pockets, and other clinical findings that can be managed using an interventional procedure can decrease the time to diagnosis and treatment, leading to improved patient outcomes 3 , 4 . The bedside operation of these POC instruments enables measurement of diagnostic information without the need to transport the patient to a centralized-care facility – reducing cost, time to treat, and in some cases, length of stay 5 .…”