Background: A growing number of hospitalists are incorporating point-of-care ultrasound (POCUS) into their daily practice to answer specific diagnostic questions or guide performance of invasive bedside procedures. This study at a 464 bed community hospital investigated hospital medicine department physicians’ choices regarding POCUS as a branch point in clinical decision making.
Methods: During shifts covering all days of the week, including daytime and nighttime hours, hospital medicine department physicians trained in POCUS (via SHM/CHEST certificate of completion program) were surveyed whenever bedside ultrasound was used. Questions focused on the role of POCUS in clinical management and on tests avoided because of ultrasonography use. Components in a workup avoided category were enumerated and aggregated for each encounter. Current Procedural Terminology (CPT) codes were designated for each component and cost savings attributable to POCUS were calculated using FairHealth data (cost to the patient or private insurer with or without insurance).
Results: 50 uses of POCUS were evaluated over 28 shifts. On average, for each time it was used for a clinical indication, POCUS eliminated $433.60 of additional testing for in-network insured patients, $742.74 for out-of-network or uninsured patients. 16 of which (32%) resulted in a change in diagnosis, 21 of which (42%) resulted in a change in management as determined by the attending physician on shift. 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 diagnoses or management (p < .001).
Conclusions: In the diagnostic process, hospitalist’s clinical expertise, in conjunction with POCUS use resulted in significant cost saving. POCUS, when incorporated earlier and more frequently into hospital medicine diagnostic and management protocols, could lower direct and indirect costs. Hospital medicine departments, in particular, would benefit from evaluating specific clinical care pathways for the integration of POCUS into the diagnostic process given the cost savings and overall value it brings to the care of the patient.