Are point-of-care ultrasounds ready for prime time?
Key Takeaways
An emerging focus of undergraduate medical education is point-of-care ultrasound (POCUS), which refers to a limited ultrasound examination done at bedside to investigate clinical conditions and help plan treatment. It can also be used to guide procedures. To date, 60% of medical schools have incorporated POCUS in their curriculum.
But, POCUS is not only useful to medical students—attending physicians can find benefit from the practice and cultivate this interventional skill set.
Competencies
POCUS can be divided into four competencies by medical school educators, according to the authors of an article published in The Ultrasound Journal. These include the following:
Indications for doing POCUS
Operation of the ultrasound machine and analyzing diagnostic images
Identifying pathology
Using POCUS results to guide patient care
Uses
Specialists use POCUS for a variety of conditions. It is used in musculoskeletal disease to image soft tissue tears, such as those of the muscles and joints, as well as visualize tumors or calcifications and synovitis and bone erosion. In cardiology, it is used in the ED for cardiac arrest, trauma, chest pain, dyspnea, and shock. In terms of needle guidance, ultrasound helps with lumbar puncture. It also aids with determining venous access and tracing out the nerve plexus for nerve blocks, as well as in epidurals. Consequently, anesthesiologists have found POCUS helpful.
Research shows that POCUS can also benefit rapid response teams (RRTs).
In a prospective, observational, controlled study published in Critical Care, French researchers switched two teams every other day in the care of 165 patients with acute respiratory or circulatory failures. One team used POCUS and the other did not.
The number of adequate immediate diagnoses was 94% in the POCUS group and 80% in the control arm. In the intervention arm, time to first treatment was 15 minutes compared with 34 minutes in the control. The POCUS group’s death rate was 17% compared with 35% in the controls.
“Our clinical trial suggests that protocolized use of a handheld POCUS device at the bedside in the ward by RRT (rapid response team) may improve the proportion of adequate diagnosis, the time to initial treatment and perhaps also survival of ward patients developing acute respiratory and/or circulatory failure,” the authors wrote. “However, because the control group was slightly sicker than the POCUS group, our results need to be confirmed by future multicenter, randomized, controlled trials.”
Benefits
In terms of cost, POCUS is cheaper than CT or MRI, and easier to use, establishing continuity of care. According to a feature article published in Imaging Technology News, ultrasound is about 60%-70% of the cost of MRI. Moreover, unlike MRI, it can be used in patients with metal implants.
On a related note, POCUS is CPT billable and can bring in additional revenue to the practice, as long as the modality’s use is medically necessary and documented in the patient’s chart. Certain states, however, require providers who have not received postgraduate training in POCUS to obtain certification.
Another benefit of ultrasound is that it bolsters the physician-patient relationship. Using screens, patients can view their scans and take a greater role in treatment.
Training
Fortunately, you don’t need to be in medical school or residency to train in POCUS. The American Institute of Ultrasound in Medicine (AIUM) offers accreditation for practices that demonstrate proficiency in performing and interpreting ultrasound findings.
Practices that have been accredited by the AIUM demonstrate proficiency in ultrasound personal education/training, instrumentation, procedures, and more.
The AIUM has an online learning center and offers CME in addition to annual meetings.
Another option is POCUS certification, which is available through the Alliance for Physician Certification & Advancement (APCA). Physicians and other advanced providers can take POCUS assessments at any time to receive a POCUS Generalist Certification, with a focus on primary care, or the POCUS Emergency Medicine Certification.
Bottom line
POCUS can be a beneficial addition to your arsenal of clinical skills and tools. It can also be a cost-efficient option that facilitates continuity of care and strengthens patient management and engagement. If interested in learning more, the AIUM and APCA offer courses and training.