Journal article
Demonstrating Feasibility of Point of Care Ultrasound (POCUS)-Guided Inpatient Transthoracic Echo Triage Decision Pathway
POCUS journal, Vol.10(1), pp.45-52
04/2025
DOI: 10.24908/pocusj.v10i01.17776
PMCID: PMC12057477
PMID: 40342674
Abstract
Prolonged inpatient length of stay (LOS) is associated with worse clinical outcomes and increased healthcare costs. Transthoracic echocardiography (TTE) is commonly utilized in cardiac evaluation of hospital inpatients but is associated with prolonged LOS and may not always be necessary. Point of care ultrasound (POCUS) may help reduce the need for inpatient TTEs.
We aimed to demonstrate the feasibility of a POCUS-guided TTE triage protocol and estimate its impact on inpatient TTE utilization.
From September to December 2023, inpatient clinicians and participating patients at a large academic institution were surveyed about their perspectives and experiences with POCUS. Cardiac POCUS exams were performed and interpreted for pre-specified clinical indications by POCUS-trained hospitalists, then reviewed independently by at least two board-certified cardiologists. Interpretations were compared using pairwise agreement analysis (kappa (κ) statistic). Finally, hospitalists and cardiologists independently offered their TTE triage recommendation, categorized as either inpatient, outpatient, or cancellation. Triage agreement between the two groups was reported as a percentage of overall cases.
Clinicians and patients were receptive to integrating POCUS exams into clinical care. Ninety POCUS exams were completed during the intervention period, on average 22 hours before TTE. Hospitalist and cardiologist agreement was moderate to very good (0.57-0.99) for specific cardiac findings. The hospitalist and at least one cardiologist agreed that 59 (66%) of 90 exams performed within the triage pathway could result in deferral or cancellation of inpatient TTE.
A POCUS-guided TTE triage protocol can reduce low-value inpatient TTE use, potentially expediting necessary TTEs and reducing TTE backlog.
Details
- Title: Subtitle
- Demonstrating Feasibility of Point of Care Ultrasound (POCUS)-Guided Inpatient Transthoracic Echo Triage Decision Pathway
- Creators
- Stephanie M Conner - Saint Louis University HospitalMustafa Husaini - Washington University in St. LouisMaya Fiore - Saint Louis University HospitalMohamed Ramadan - Saint Louis University HospitalBenjamin Hoemann - Saint Louis University HospitalNicholas Arnold - Washington University in St. LouisFarhan Katchi - Washington University in St. LouisCrystal Atwood - Washington University in St. LouisCarol Faulk - Saint Louis University HospitalKarl Wallenkampf - Washington University in St. LouisJing Li - Washington University in St. Louis
- Resource Type
- Journal article
- Publication Details
- POCUS journal, Vol.10(1), pp.45-52
- DOI
- 10.24908/pocusj.v10i01.17776
- PMID
- 40342674
- PMCID
- PMC12057477
- NLM abbreviation
- POCUS J
- ISSN
- 2369-8543
- eISSN
- 2369-8543
- Language
- English
- Date published
- 04/2025
- Academic Unit
- Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984945079902771
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