Conner Stephanie M, Husaini Mustafa, Fiore Maya, Ramadan Mohamed, Hoemann Benjamin, Arnold Nicholas, Katchi Farhan, Atwood Crystal, Faulk Carol, Wallenkampf Karl, Li Jing
Washington University in St. Louis, Department of Medicine, Division of Hospital Medicine, St. Louis, MO, USA.
Columbia University Irving Medical Center, Department of Medicine, Division of General Medicine, New York, NY, USA.
POCUS J. 2025 Apr 15;10(1):45-52. doi: 10.24908/pocusj.v10i01.17776. eCollection 2025 Apr.
Prolonged inpatient length of stay (LOS) is associated with worse clinical outcomes and increased healthcare costs. Transthoracic echocardiography (TTE) is commonly utilized in cardiac evaluation of hospital inpatients but is associated with prolonged LOS and may not always be necessary. Point of care ultrasound (POCUS) may help reduce the need for inpatient TTEs.
We aimed to demonstrate the feasibility of a POCUS-guided TTE triage protocol and estimate its impact on inpatient TTE utilization.
From September to December 2023, inpatient clinicians and participating patients at a large academic institution were surveyed about their perspectives and experiences with POCUS. Cardiac POCUS exams were performed and interpreted for pre-specified clinical indications by POCUS-trained hospitalists, then reviewed independently by at least two board-certified cardiologists. Interpretations were compared using pairwise agreement analysis (kappa (κ) statistic). Finally, hospitalists and cardiologists independently offered their TTE triage recommendation, categorized as either inpatient, outpatient, or cancellation. Triage agreement between the two groups was reported as a percentage of overall cases.
Clinicians and patients were receptive to integrating POCUS exams into clinical care. Ninety POCUS exams were completed during the intervention period, on average 22 hours before TTE. Hospitalist and cardiologist agreement was moderate to very good (0.57-0.99) for specific cardiac findings. The hospitalist and at least one cardiologist agreed that 59 (66%) of 90 exams performed within the triage pathway could result in deferral or cancellation of inpatient TTE.
A POCUS-guided TTE triage protocol can reduce low-value inpatient TTE use, potentially expediting necessary TTEs and reducing TTE backlog.
住院时间延长与更差的临床结局及医疗成本增加相关。经胸超声心动图（TTE）常用于住院患者的心脏评估，但与住院时间延长有关，且可能并非总是必要的。床旁超声（POCUS）可能有助于减少住院患者进行TTE的需求。
我们旨在证明POCUS引导的TTE分诊方案的可行性，并评估其对住院患者TTE使用的影响。
2023年9月至12月，对一家大型学术机构的住院临床医生和参与研究的患者进行了关于他们对POCUS的看法和经验的调查。由接受过POCUS培训的住院医师针对预先指定的临床指征进行心脏POCUS检查并解读，然后由至少两名获得委员会认证的心脏病专家独立审核。使用配对一致性分析（kappa（κ）统计量）比较解读结果。最后，住院医师和心脏病专家独立给出他们的TTE分诊建议，分为住院、门诊或取消。两组之间的分诊一致性以占总病例数的百分比报告。
临床医生和患者都愿意将POCUS检查纳入临床护理。在干预期内完成了90次POCUS检查，平均在TTE前22小时进行。对于特定的心脏检查结果，住院医师和心脏病专家的一致性为中等至非常好（0.57 - 0.99）。住院医师和至少一名心脏病专家一致认为，在分诊流程中进行的90次检查中有59次（66%）可以推迟或取消住院患者的TTE。
POCUS引导的TTE分诊方案可以减少低价值的住院患者TTE使用，可能加快必要的TTE检查并减少TTE积压。
