Scope of point-of-care ultrasound practice in rural New Zealand

Nixon, Garry; Blattner, Katharina; Muirhead, Jillian; Finnie, Wendy; Lawrenson, Ross; Kerse, Ngaire

doi:10.1071/hc18031

Cited by 15 publications

(24 citation statements)

References 15 publications

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“…The use of HH-POCUS in hospitals and particularly in EDs and ICUs has expanded rapidly in recent years [16], while its role in the outpatient care setting is not yet established [17]. To better examine the needs and potential advantages in different areas, we divided the participants into four groups consisting of PCPs, GPs, EPs, and PCNs.…”

Section: Impact On Patient Care and Local Resourcesmentioning

confidence: 99%

Ambulatory Use of Handheld Point-of-Care Ultrasound (HH-POCUS) in Rural Brandenburg – A Pilot Study

Frauendorf²,

Wischke

et al. 2021

Ultraschall Med

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Purpose This study aims to evaluate the use of handheld ultrasound devices (HHUS) for point-of-care ultrasound (POCUS) to improve outpatient care in rural Brandenburg. Materials and Methods A group of general practitioners (n = 9), palliative care physicians (n = 6), emergency physicians (n = 4), and nurses from palliative care services (n = 5) participated in this study. Following a 3-hour workshop and 2 weeks of individual training, participants performed POCUS using HHUS (HH-POCUS). Indications, examination results, and resulting treatment changes (e. g., acute interventions, new medication) were documented in a standardized data entry form. Results 19 physicians with different ultrasound experience and 5 palliative care nurses attended the workshop program and took part in the study. Three of the participating physicians were out of training in ultrasound and received prolonged supervision. Among 427 HH-POCUS examinations, the FAST scan and kidney scan were performed most often. Pain and dyspnea were the most common indications for HH-POCUS. Among the examinations performed by physicians (n = 311), ascites was the most common pathology (27 % of cases). Using a simplified examination protocol, palliative care nurses diagnosed fluid collections, hydronephrosis and transurethral catheter position or urinary retention. In 80.4 % of physician-performed cases, HH-POCUS made a valuable impact on patient management. HH-POCUS contributed to treatment decisions in 49.5 % of cases, including a change of medication in 29.6 % and performance of therapeutic interventions in 19.9 %. Hospital admission or referral to an ambulatory specialist was initiated due to HH-POCUS findings in 17.7 % of patients. Conclusion HH-POCUS helped doctors in rural areas to optimize patient care through rapid on-site collection of therapeutically relevant findings. In addition, it was shown that specialized and motivated nurses can independently detect simple ultrasound findings and thus provide clinically relevant information to doctors.

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Section: Impact On Patient Care and Local Resourcesmentioning

confidence: 99%

Ambulatory Use of Handheld Point-of-Care Ultrasound (HH-POCUS) in Rural Brandenburg – A Pilot Study

Frauendorf²,

Wischke

et al. 2021

Ultraschall Med

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“…Point‐of‐care ultrasound is preferred in our typology over CT as ultrasound training is part of the core competency training in the Royal College of Physicians of Canada EM Fellowship Program and in the Australian College or Rural and Remote Medicine Program, which is also available in New Zealand, 21,45,46 the technology is more affordable and portable, and has greater sensitivity, specificity and accuracy than other imaging modalities for certain pathologies such as pneumonia and pneumothoraces 47,48 . In Australia and New Zealand, ultrasound is routinely available in rural EDs and has been found to be a valuable diagnostic imaging modality particularly for presentations of acute chest or abdominal pain 49,50 …”

Section: Discussionmentioning

confidence: 99%

Rural emergency departments: A systematic review to develop a resource typology relevant to developed countries

Kerr

Kealy

Lim

et al. 2021

Australian J Rural Health

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Objective Despite low patient numbers, rural emergency departments have a similar diversity of case presentations as urban tertiary hospitals, with the need to manage high‐acuity cases with limited resources. There are no consistent descriptions of the resources available to rural emergency departments internationally, limiting the capacity to compare clinical protocols and standards of care across similarly resourced units. This review aimed to describe the range of human, physical and specialist resources described in rural emergency departments in developed countries and propose a typology for use internationally. Design and setting A systematic literature search was performed for journal articles between 2000 and 2019 describing the staffing, access to radiology and laboratory investigations, and hospital inpatient specialists. Results Considerable diversity in defining rurality and in resource access was found within and between Australia, New Zealand, Canada and USA. Discussion A typology was developed to account for (a) emergency department staff on‐floor, (b) emergency department staff on‐call, (c) physical resources and (d) access to a specialist surgical service. This provides a valuable tool for relevant stakeholders to effectively communicate rural emergency department resources within a country and internationally. Conclusion The proposed five‐tiered typology draws together international literature regarding rural emergency department services. Although further research is required to test this tool, the formation of this common language allows a base for effective communication between governments, training providers and policy‐makers who are seeking to improve health systems and health outcomes.

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“…This study is a subgroup analysis of a larger study examining the safety and effect of POCUS on patient care in rural New Zealand. 1,7 Twenty-eight rural generalist doctors, working in six rural NZ hospitals were enrolled in the study over a 9-month period in 2012. Three of the study hospitals were in the North Island and three in the South Island.…”

Section: Methodsmentioning

confidence: 99%

“…Point-of-care ultrasound (POCUS) of the kidney and bladder are the fourth and sixth most commonly performed POCUS examinations by New Zealand rural doctors respectively. 1 POCUS of the kidney is also commonly performed in emergency departments, a practise that is supported by the emergency medicine literature. 2 The principal finding being sought is hydronephrosis, usually when the differential diagnosis includes renal colic.…”

Section: Introductionmentioning

confidence: 94%

Rural point-of-care ultrasound of the kidney and bladder: quality and effect on patient management

et al. 2018

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INTRODUCTION Point-of-care ultrasound (POCUS) of the kidney and bladder are among the most commonly performed POCUS scans in rural New Zealand (NZ). AIM To determine the quality, safety and effect on patient care of POCUS of the kidney and bladder in rural NZ. METHODS Overall, 28 doctors in six NZ rural hospitals completed a questionnaire both before and after undertaking a POCUS scan over a 9-month period. The clinical records and saved ultrasound images were reviewed by a specialist panel. RESULTS The 28 participating doctors undertook 138 kidney and 60 bladder scans during the study. POCUS of the bladder as a test for urinary retention had a sensitivity of 100% (95% CI 88–100) and specificity of 100% (95% CI 93–100). POCUS of the kidney as a test for hydronephrosis had a sensitivity 90% (95% CI 74–96) and specificity of 96% (95% CI 89–98). The accuracy of other findings such as renal stones and bladder clot was lower. POCUS of the bladder appeared to have made a positive contribution to patient care in 92% of cases without evidence of harm. POCUS of the kidney benefited 93% of cases, although in three cases (2%), it may have had a negative effect on patient care. DISCUSSION POCUS as a test for urinary retention and hydronephrosis in the hands of rural doctors was technically straightforward, improved diagnostic certainty, increased discharges and overall had a positive effect on patient care.

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Scope of point-of-care ultrasound practice in rural New Zealand

Cited by 15 publications

References 15 publications

Ambulatory Use of Handheld Point-of-Care Ultrasound (HH-POCUS) in Rural Brandenburg – A Pilot Study

Ambulatory Use of Handheld Point-of-Care Ultrasound (HH-POCUS) in Rural Brandenburg – A Pilot Study

Rural emergency departments: A systematic review to develop a resource typology relevant to developed countries

Rural point-of-care ultrasound of the kidney and bladder: quality and effect on patient management

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