School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
Departments of Emergency Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
J Ultrasound Med. 2021 Sep;40(9):1803-1809. doi: 10.1002/jum.15560. Epub 2020 Nov 10.
Point-of-care ultrasound (POCUS) is a widely used diagnostic modality in the emergency physician's tool kit. The effect on health care costs is disputed. This study examined whether POCUS was associated with system-level cost savings. Secondary objectives included adverse patient outcomes and the association between POCUS use and diagnostic costs in specific patient groups.
The Point-of-Care Ultrasound Use and Monetary Outcomes study was a single-center prospective observational study. A convenience sample of emergency medicine physicians working from July to October 2019 were included after using POCUS as part of their assessment. The cost of patient investigations was compared with those proposed by a control group of physicians simultaneously on shift, who were blinded to the POCUS findings. Ethical approval was obtained from the Queen's University Health Sciences Research Ethics Board.
Fifty patient assessments using POCUS were included. Overall, the median investigation cost in United States dollars in the POCUS group was $102.00 (interquartile range [IQR], $39.80-$167.90) versus $122.40 (IQR, $70.96-$175.60) in controls (P = .08). When stratified by disposition, POCUS use in patients discharged home resulted in a median expenditure of $71.80 (IQR, $36.48-$116.70) versus $122.70 (IQR, $71.18-$183.20; P < .001). Significant cost savings were also found in flank pain presentations (median, $138.90; IQR, $136.60-$186.10; P = .01). There were no differences in the quantity of investigations ordered, the patient emergency department repeated presentation rate, or safety outcomes at 7 days.
Point-of-care ultrasound use was not associated with significant cost savings in our overall population. The subgroup analysis revealed significant POCUS-associated cost savings in patients discharged home and those presenting with flank pain. Notably, POCUS was not associated with an increase in adverse patient safety outcomes.
床边超声（POCUS）是急诊医师工具包中广泛使用的诊断方式。其对医疗成本的影响存在争议。本研究旨在探讨 POCUS 是否与系统层面的成本节约相关。次要目标包括患者不良结局，以及 POCUS 使用与特定患者群体诊断成本之间的关系。
POCUS 使用与货币结果研究是一项单中心前瞻性观察性研究。2019 年 7 月至 10 月期间，在将 POCUS 用作评估的一部分后，纳入了使用 POCUS 的急诊医学医师的便利样本。将患者检查的费用与同时在班的对照组医师提出的费用进行比较，对照组医师对 POCUS 结果不知情。该研究获得了皇后大学健康科学研究伦理委员会的批准。
共纳入 50 例使用 POCUS 的患者评估。总体而言，POCUS 组的美元中位数检查费用为 102.00 美元（四分位距 [IQR]，39.80-167.90），而对照组为 122.40 美元（IQR，70.96-175.60；P=0.08）。按处置分层，在出院回家的患者中使用 POCUS 导致中位数支出为 71.80 美元（IQR，36.48-116.70），而对照组为 122.70 美元（IQR，71.18-183.20；P<0.001）。在腰痛患者中也发现了显著的成本节约（中位数，138.90 美元；IQR，136.60-186.10；P=0.01）。在检查数量、患者急诊科重复就诊率或 7 天内的安全性结局方面，两组间无差异。
在我们的总体人群中，POCUS 使用与显著的成本节约无关。亚组分析显示，在出院回家的患者和腰痛患者中，POCUS 与显著的 POCUS 相关成本节约相关。值得注意的是，POCUS 与不良患者安全结局增加无关。
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