Point of care ultrasound for rapid assessment and treatment of palliative care patients in acute medical settings

Abstract

The combination of an ageing population with improving survival in malignant and non-malignant disease processes results in a growing cohort of patients with advanced or end-stage chronic diseases who require acute medical care. Emergency care has historically been stereotyped as the identification and treatment of acute lifethreatening problems. Although palliative care may be considered to be new to the formal curriculum of emergency medicine, in many domains the ultrasound skillset of a physician in acute medical care can be efficaciously deployed the benefit of patients with both malignant and non-malignant disease processes that require palliative care in the full breadth of acute healthcare settings.In diagnostic domains (abdominal pain, urinary tract obstruction, dyspnoea, venous thromboembolism and musculoskeletal pain) and for specific intervention guidance (thoracentesis, paracentesis, venous access, regional anaesthesia and musculoskeletal interventions) we suggest that POCUS has the potential to streamline improve patient satisfaction, streamline diagnostic strategies, optimise patient length of stay, expedite timely symptomatic relief and reduce complications in this important patient population.POCUS is a mandatory competence in the European curriculum of internal medicine, and specific training programs which cover applications in the domains of palliative care in acute care settings are available. Supervision, quality assurance and appropriate documentation are required. We expect that as the availability of mobile units suitable for point of care applications increases, these applications should become standard of care in the acute management of patients who require palliative care.

Time to FOCUS - ‘Palliative Medicine Point-of-Care Ultrasound’

“…The aim of POCUS in palliative care is towards empowering technology reaching out to the community rather than the terminally ill patient reaching out to seek hospital admission. [1,15] Mobile care units that could transform home care in palliative care medicine practice need to be equipped with POCUS machines. These mobile care units could be deployed for home visits or be utilised in a hospice setting; wherein acute medical management of palliative care patients could be performed.…”

“…Similarly, the inclusion of ultrasound machine in an outpatient palliative care clinic brings about value addition in rapid diagnosis and may alter treatment trajectories by expediting symptom relief and thereby reducing length of stay in the hospital. [1,[15][16][17][18][19] Ultrasound devices have become compact, portable and easily accessible towards empowering palliative care.…”

“…Handheld ultrasound devices have transformed the application of POCUS in the home-based palliative care setting. [1,20,21] Palliative care physicians should receive mandatory training in POCUS to enable diagnostic proficiency. This would need acquiring higher training, as well as improvised skill sets, along with overcoming the associated implementation barriers to effective clinical practice.…”

“…[22][23][24] Ultrasonography competency among palliative care providers could be achieved by imparting dedicated POCUS training within the core curriculum. [1,2,9,22,23] This review aims to explore the application, importance and feasibility of POCUS in various diagnostic and therapeutic interventions of palliative care medicine. A database search was performed using the terms 'Palliative medicine' and POCUS and 'point-of-care ultrasound' .…”

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Ultrasound skillset in palliative care stems from the extension of internal medicine, emergency medicine, family medicine and intensive care principles into palliative medicine. [1][2][3][4][5][6] Point-of-care diagnosis has become the need of the hour and along with its guided interventions; ultrasound could be used bedside in a palliative care patient. Point-of-care ultrasound (POCUS) has been defined as performance of ultrasound imaging by the treating clinician at patient's bedside and it differs from routine ultrasound imaging which is usually performed by a radiologist in a hospital setup.

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