Cardiopulmonary point-of-care ultrasound was associated with a reduction of 246 hospital bed-days and $3,055 per bed-day saved among 208 patients experiencing shortness of breath, according to a study published Sept. 5 in JAMA Network Open.
Despite the cost savings, only 20% of hospitalists used POCUS independently, underscoring “the need for ongoing training, support, and professional incentives to strengthen competency and motivation,” the study authors wrote.
The study, led by Partho Sengupta, MD, chief of cardiovascular medicine at Rutgers Robert Wood Johnson Medical School and the Robert Wood Johnson University Hospital, both based in New Brunswick, N.J., took place between Dec. 7, 2023, and July 2, 2024.
His team included Kameswari Maganti, MD, section chief of noninvasive cardiology and director of the echocardiography laboratory at Robert Wood Johnson University Hospital, as well as Catherine Chen, MD, associate vice chair of quality and safety in the department of medicine, Naveena Yanamala, PhD, section chief of clinical research and AI innovation and director of data science and machine learning, and Payal Parikh, MD, assistant dean for transformation and integration, all at the Rutgers Robert Wood Johnson Medical School.
Dr. Sengupta spoke to Becker’s about the study’s findings, including what it may mean for the future of cardiovascular medicine.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What do these official findings suggest about the role point-of-care ultrasound can play in helping hospitals manage capacity and costs?
Dr. Partho Sengupta: Shortness of breath is a very common presentation in emergency rooms, which triggers investigations for heart failure. It can be a very complex scenario; you have to diagnose them [with heart failure] in time, treat them and make sure they are not going to have recurrent readmissions.
We wanted to do a pragmatic study with a training component for hospitalists, who typically have not used point-of-care ultrasound technology. For the study, we had a plan B where if a hospitalist could not use the technology, a sonographer or cardiologist — at a remote distance — could keep the process moving forward.
We found that the length of stay reduced an average of about three days, and we were able to reduce overall costs by about $750,000 among 208 patients. Additionally, this strategy was not associated with a rebound increase in readmissions.
Q: How do you predict being able to increase utilization among hospitalists?
PS: We need to go back to the drawing board and make it essential that people get the training and the competency needed to do these tests, while also establishing a way to incentivize use.
Perhaps instead of having people do the imaging, we have a technological revolution where AI and automated tools capture the information, freeing up the hospitalist. One specific model, which I’ve seen in my own group, is having hospitalist champions.
At the end of the day, the solution cannot be one size fits all because different places will have different needs.
Q: As cardiovascular disease and heart failure cases rise nationally, do you see point-of-care ultrasound becoming a standard of care? Does it complement or replace traditional imaging and diagnostic approaches?
PS: Point-of-care ultrasound has been here for a long period of time; however, uptake has been very heterogeneous. Not everybody yet practices point-of-care ultrasound, so I think now is the time for us to be more proficient and to embrace it more closely.
Point-of-care ultrasound should be viewed as something that needs to be done on every patient and as a metric of excellence. It’s not always about work RVUs. Sometimes it’s also about patient care, throughput, efficiency and creating capacity.
Use of technology — wearables, AI, ECG — is going to change how we screen and detect cardiovascular disease earlier. This may be something that we can think about somewhat controversially — if you do a colonoscopy after 45 years, why not point-of-care ultrasound?
We are also not training the same number of sonographers or physicians while heart failure is already flooding our hospitals. We need to have other automated ways to capture the information. The future is going to look very bleak if we don’t move toward early detection. There’s a lot of development happening with ultrasound technologies that will help us with this epidemic of heart failure and cardiovascular diseases.
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