The research team proposed that utilizing point-of-care ultrasound (POCUS) can help triage inpatient transthoracic echocardiography (TTE) necessity. TTE is a clinical tool used for cardiac evaluation of hospitalized patients; the TTE worklist, however, can get lengthy and TTE orders are frequently associated with greater hospital length of stay. POCUS is a clinician performed, limited bedside ultrasound that answers targeted clinical questions. Studies have demonstrated that trained hospitalists and residents can perform and interpret cardiac POCUS exams with non-inferiority to cardiologists for specific clinical indications. The goal of the study is to demonstrate the feasibility of a POCUS guided TTE triage protocol and model impact on inpatient TTE utilization.
The first phase of the study required collecting baseline data from patients on medical floors. They were asked a series of questions relating to their overall experience and satisfaction. Clinicians were also administered a survey; 153 clinician surveys were completed. Overall, clinicians perceived that diagnostic testing was not performed in a timely manner and were receptive to POCUS use in triaging TTE orders.
From September-December 2023, the team collected data. Eligible patients were identified via EPIC TTE worklist using a convenience sample approach. POCUS clinicians performed a limited cardiac ultrasound on eligible patients and saved deidentified images on a secure cloud-based databank. They recorded clinical history, assessment of POCUS image quality and interpretation, and TTE triage recommendation via Redcap survey. Clinical information and POCUS images were reviewed by two cardiologists independently for image quality, interpretation and TTE triage recommendation.
Our results revealed that a POCUS-guided TTE triage protocol is feasible to reduce unnecessary inpatient TTE orders for certain clinical conditions, which is likely to expedite inpatient TTE completion. Further investigation of this feasibility study is underway to guide implementation.
We are looking forward to hearing more about this research at the SHM conference.