Point-of-Care Ultrasound in the Inpatient Setting: A Tale of Four Patients

Renee K. Dversdal, MD; KevinM. Piro, MD; Charles M. LoPresti, MD; Noelle M. Northcutt, MD; Daniel J. Schnobrich, MD

Disclosures

South Med J. 2018;111(7):382-388. 

In This Article

Conclusions

As demonstrated by these cases, POCUS has considerable potential to improve the physical assessment, differential diagnosis creation, and clinical decision making of hospital-based physicians. A proliferation of US teaching in medical schools and residency training across medical education and increasing engagement by professional societies governing hospital-based physicians are encouraging signs that this potential will be fulfilled. Numerous challenges and opportunities lie ahead as hospital physicians engage with POCUS. Defining what constitutes adequate training and creating accessible pathways to provide this training remain major challenges for hospitalists wishing to use POCUS. Training by high-quality didactics, hands-on learning, and a period of experiential learning tailored to each application is likely optimal because the ease of acquiring a diagnostic image varies across the modalities. Literature from emergency medicine shows 25 scanning examinations may be an appropriate period of experiential learning for many learners for many applications.[56–58] This is not universally accepted, however, and some applications such as right upper quadrant image interpretation may have a longer learning curve.[59] It is further a point of debate whether this rigor is needed for hospitalists who wish to do only a few simple applications, such as the evaluation of internal jugular distension or the identification of pleural effusions. Nonetheless, access to high-quality training remains limited both for general medicine physicians and practicing hospitalists.

Mechanisms exist to ensure the high-quality use of POCUS in hospitalist programs;[2] however, there remains disagreement about whether or how to formally determine which hospitalists should perform POCUS, for which applications, and whether archiving of images should always be required. Although many emergency medicine physicians generally are governed by hospital credentialing, it is not universally agreed that this approach is best for hospitalists in an era in which US is being taught in many medical schools along with other physical assessments and handheld technology is increasingly available.

Finally, the literature surrounding hospitalist-specific POCUS remains underdeveloped[60] and relies heavily on research from other specialties. Hospitalist-specific literature is needed to ensure that this technology is used as appropriately as possible. In addition, the effect on factors such as workflow, length of stay, readmissions, costs, and patient satisfaction remain relatively unaddressed.

Strong engagement will be necessary from researchers, educational institutions, professional societies, and hospitals to bring the full potential of POCUS to hospital medicine. We believe that as hospitalists continue to engage with POCUS, they will confirm and build upon successes achieved by other acute care physicians, while also developing new skills and applications useful to their practice.

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