Overview
This observational study examined the role of clinician-performed ultrasound (CPU) in six New Zealand rural hospitals over a nine-month period. It examined quality and safety by reviewing recorded images and comparing results with those of formal imaging. Impact on patient management was evaluated by reviewing clinical records. The extent to which the CPU impacted on patient disposition (discharge, admission to rural hospital, or transfer to a base hospital) was assessed by recording the clinician's planned management both before and after undertaking the CPU.
Over 1000 scans were included in the study. The most commonly performed scans were cardiac, IVC, gallbladder, kidney, and focused assessment with sonography for trauma (FAST). Image quality was assessed as good in 62%, adequate in 31%, and non-diagnostic in 7%, of cases. Clinicians correctly interpreted their images in 90% of cases. In 8% of cases the disposition was deescalated, resulting in a financial saving to the healthcare system, and in 4% of cases it was escalated, resulting in improved patient outcomes.
Overall impact on patient management
In 26% of cases the specialist panel decided that the CPU had no or minimal impact on management. In 48.6% of cases there was some impact, for 22% of cases the impact was significant, and for 0.4% of cases the CPU had a potentially life saving-impact. In 3% of cases the CPU was judged to have had a negative impact on patient care. In 17 cases this was in the form of an incorrect diagnosis. In six cases it was a delay in accessing definitive investigation or treatment, and in four cases it was determined that an alternative imaging modality should have been used.
This study suggests that rural New Zealand doctors have a broader scope of CPU practice than their urban emergency physician colleagues. Overall CPU appears to have a positive impact on patient care and, by reducing inter-hospital transfers, results in savings to the healthcare system.
The study was funded by the Health Research Council 2011 / 2012.
Investigators
Dr Garry Nixon
Dr Kati Blattner
Partners
Hokianga Health Services
Central Otago Health Services
Status
The final write-up is being prepared. Articles are being prepared for publication.