Point‐of‐Care Ultrasonography (POCUS) in a Community Emergency Department: An Analysis of Decision Making and Cost Savings Associated With POCUS

Abstract

Objectives Point‐of‐care ultrasonography (POCUS) is an increasingly integral part of emergency medicine. This study investigated community emergency department physicians’ choices regarding ultrasonography as a branch point in clinical decision making. Methods During shifts covering all days of the week and all time‐spans over a 3‐month period, emergency department physicians were interviewed whenever POCUS was used. Questions focused on the role of POCUS in clinical management and on tests avoided because of ultrasonography use. Cost savings attributable to POCUS were calculated using Center for Medicare and Medicaid Services and FairHealth data. Anonymization of data precluded follow‐up testing to account for misdiagnosis. Results On average, POCUS use eliminated $1134.31 of additional testing for privately insured patients, $2826.31 for out‐of‐network or uninsured patients, and $181.63 for Center for Medicare and Medicaid Services patients. Differences were significant when the total cost of eliminated additional testing was compared to a baseline of no savings (p < .001). Aggregate cost savings remained significant when analyses were broadened to include POCUS encounters that did not yield changes in management (p < .001). Conclusions When physicians’ clinical expertise suggests that POCUS may be indicated, its use results in significant cost savings, even in encounters in which management is not directly impacted. POCUS, when incorporated earlier and more frequently into community hospital emergency medicine diagnostic protocols, can lower direct and indirect costs associated with diagnostic workups. Community emergency departments, in particular, would benefit from additional investigation informing specific guidelines for the integration of POCUS into clinical management and the role that this has in cost savings.

A systematic review of the cost-effectiveness of ultrasound in emergency care settings

“…Finally, we identified a collection of studies evaluating the downstream impact of emergency US on resource utilization [48][49][50][51][52]. One study found that patients who had POCUS as opposed to radiology scans were at increased risk of having further confirmatory studies ordered compared to those who had the initial US done by radiology [50].…”

Future‐proofing clinical education

“…Although ultrasound has been integrated well into undergraduate medical education in the USA, this cannot be said for the UK, with few medical schools integrating longitudinal ultrasound education into the curriculum here . Furthermore, the use of HHU may lead to significant savings to the health system, when used appropriately …”

COVID‐19 Pandemic Prompts a Paradigm Shift in Global Emergency Medicine: Multidirectional Education and Remote Collaboration

“…When used in carefully selected settings, telemedicine services can save costs over equivalent in‐person care 39–41 . Point‐of‐care diagnostics such as rapid diagnostic tests and point‐of‐care ultrasound may reduce facility cost through rapid delivery of results 42,43 . Learning strategies previously discussed, including MOOCs and Free Open Access Medicine (FOAMed), not only enable information to reach a broader audience and permit ongoing information sharing during a global pandemic but also result in reduced spending by learners 44,45 .…”

“…[39][40][41] Point-of-care diagnostics such as rapid diagnostic tests and point-of-care ultrasound may reduce facility cost through rapid delivery of results. 42,43 Learning strategies previously discussed, including MOOCs and Free Open Access Medicine (FOAMed), not only enable information to reach a broader audience and permit ongoing information sharing during a global pandemic but also result in reduced spending by learners. 44,45 Previously, access to critical appraisals of current medical literature was only available through expensive subscriptions, while now FOAMed resources like Journalfeed and Emergency Medicine Literature of Note allow individuals to access equally high-quality material for free.…”