The portability, accuracy, and noninvasive nature of Point of Care Ultrasound (POCUS) allows doctors across various areas of a hospital to provide their patients with answers when and where they're needed—including right at the bedside.
Clinicians can perform a scan, save the images, and document without additional orders or waiting for radiology. This streamlined process shows both the medical and economic impact of POCUS: point-of-care ultrasound allows clinicians to make diagnoses and plan for next steps more quickly, which has benefits for patients as well as for health systems.
In the Emergency Department and Intensive Care
On top of being a critical skill for emergency medicine physicians and critical care physicians, hospitals can consider the economic impact of POCUS. In many ways, bedside ultrasound creates opportunities to save money—including through shorter stays, avoiding additional expensive imaging tests, and reduced overall costs. These financial savings extend throughout the emergency department (ED) as well as costs that go beyond the bottom line.
Avoid Additional Testing
The researchers also found that patients with Medicare and Medicaid or no insurance—groups that often have negative profit margins for hospitals—make up about 65% of the patient mix for an average hospital.1 The authors suggest that lowering direct patient costs by eliminating unnecessary charges can ultimately improve profit margins.
A Harvard study found that using POCUS led to savings of $1,134.31 for privately insured patients, $2,826.31 for out-of-network or uninsured patients, and $181.63 for patients with Medicare or Medicaid.1 These costs were realized by avoiding additional testing. Among the 49 observations included in the single-center study, 16 resulted in a change in management, which involved foregoing additional diagnostic tests. The researchers didn't quantify indirect costs, but they did find evidence that using POCUS led to faster diagnoses and increased throughput.1
In the ICU, POCUS aids clinicians with fast, accurate answers. One study of 50 patients, most in the ICU, found that POCUS was in agreement with the final diagnosis for patients 80% of the time. Within the 20% that were not, most of those studies provided additional information supporting the final diagnosis. POCUS aided fluid resuscitation, pressor alteration, and diuresis. In addition to a faster diagnosis, the researchers estimated that extrapolated cost savings from avoiding additional testing totaled more than $80,000.2
An ED in Canada also estimated savings with POCUS, finding the most savings for patients who were candidates for discharge or those who presented with flank pain. Diagnostic investigation with POCUS saved about $20 based on median costs, and the median overall investigation savings totaled about $70 per patient. Importantly, no patients were readmitted to the hospital because of a missed diagnosis with POCUS.3
Faster Examinations
Common POCUS uses in the ED include evaluation of pediatric appendicitis, trauma, renal issues, blood clots, OB/GYN issues, and heart conditions. A cost-effectiveness evaluation found that using POCUS as initial imaging for pediatric appendicitis and for trauma led to the most consistent cost savings.4 Evaluating pediatric appendicitis with POCUS first reduced overall costs and length of stay as well as spared young patients from radiation exposure.
In cases of trauma, using POCUS decreased the length of stay, lessened the use of CT scans for children, and reduced the use of invasive procedures such as peritoneal lavage in adults. POCUS also got patients with traumatic injury into surgery more quickly.4 In other areas, such as renal or venous pathology, POCUS also demonstrated potential savings, mainly from avoiding more costly imaging scans.
Musculoskeletal POCUS
POCUS has increasingly seen use in orthopedic settings for adults and children. In addition to saving time and effort for patients, the portability and lower initial cost of the ultrasound devices contribute to overall cost savings for musculoskeletal uses.
Hip Dysplasia
Infants with developmental hip dysplasia often go to radiology for formal ultrasound evaluation. Frequently, however, clinicians opt to evaluate these patients with POCUS.
One study at an outpatient orthopedic hospital evaluated 532 patient encounters, comparing those who underwent a POCUS exam against those who had a formal ultrasound.5 The mean encounter duration for the POCUS group was 42 minutes versus 92 minutes for the formal group, and the mean cost was $121.13 for the POCUS group compared with $339.38 for the formal group.5 The POCUS exam offered a significant time savings, most being complete in five minutes.
Early identification and treatment of developmental hip dysplasia can affect the future need for invasive procedures and complications. POCUS streamlines the evaluation and detection of hip dysplasia, offering answers and a faster path to treatment than formal studies, which may not always be available at the same time or in the same location as the appointment.5
Rotator Cuff Tears
Although MRI is the standard for shoulder imaging, it also contributes to the overall costs of rotator cuff tear treatment. Using POCUS for initial screening can help reduce the number of patients who undergo MRI and aid in evaluating patients for surgery, thereby reducing overall costs.
About 65% of the pre-op costs for rotator cuff surgery are related to diagnostic imaging, and MRI makes up the majority of those costs.6 POCUS, when clinically indicated, can detect rotator cuff tears with an accuracy close to that of an MRI. Studies have also found that orthopedic surgeons can learn to use POCUS relatively quickly. They can achieve accuracy in using POCUS to detect rotator cuff tears after 50 to 100 scans.6
Clinical research and cost analyses have both found benefits for incorporating POCUS into the initial management of patients across multiple specialties. POCUS evaluation can reduce the need for more costly tests, time to treatment, length of stay, and exposure to radiation. The POCUS streamlined approach may significantly lower costs for both the provider and the patient – allowing both to win.
A patient's status can change rapidly in the ICU and ED. Venue™ Family point of care ultrasound systems support fast care decisions with AI-enabled tools and a straightforward, intuitive interface.
References:
1. Van Schaik GWW, Van Schaik KD, Murphy MC. Point-of-care ultrasonography ( (POCUS) in a community emergency department: an analysis of decision making and cost savings associated with POCUS. Journal of Ultrasound in Medicine. 2019;38(8):2133-2140. https://pubmed.ncbi.nlm.nih.gov/30593670/.
2. Jones T, Leng P. Clinical impact of point of care ultrasound (POCUS) consult service in a teaching hospital: effect on diagnoses and cost savings. Chest. 2016;149(4s):A236. https://journal.chestnet.org/article/S0012-3692(16)00863-1/fulltext.
3. Rusiecki D, Douglas SL, Bell C. Point-of-care ultrasound use and monetary outcomes in a single-yayer health care setting. Journal of Ultrasound in Medicine. 2021;40(9):1803-1809. https://onlinelibrary.wiley.com/doi/10.1002/jum.15560.
4. Lentz B, Fong T, Rhyne R, Risko N. A systematic review of the cost-effectiveness of ultrasound in emergency care settings. Ultrasound Journal. 2021;13(1):16. https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-021-00216-8.
5. Herrero C, Colon Y, Nagapurkar A, Castañeda P. Point-of-care ultrasound reduces visit time and cost of care for infants with developmental dysplasia of the hip. Indian Journal of Orthopaedics. 2021;55(6):1-6. https://link.springer.com/article/10.1007/s43465-021-00541-z.
6. Kruse KK, Dilisio MF, Wang WL, Schmidt CC. Do we really need to order magnetic resonance imaging? Shoulder surgeon ultrasound practice patterns and beliefs. JSES Open Access. 2019;3(2):93-98. Published 2019 Apr 26. doi:10.1016/j.jses.2019.01.004.
