SESSION TITLE: Improving Quality and Reducing Cost
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 29, 2013 at 02:45 PM - 04:15 PM
PURPOSE: We propose that the use of point of care ultrasound in the MICU, in the hands of ultrasound trained physicians, can reduce cost by reducing the number of chest x rays and CT scans. This will reduce radiation exposure and cost. We also studied whether this reduction in radiological testing affected patient outcomes.
METHODS: Retrospective chart review comparing standard imaging xrays (chest), ct scans (head, chest, abdomen/pelvis), echocardiography, and ultrasound (dvt) between two independent, but similar medical intensive care units staffed by the same medical house staff and pulmonary/critical care fellows, in one health care system. One unit uses bedside sonography as standard of care with all physicians trained in appropriate techniques; the second uses conventional imaging as its standard of care in diagnosis/management. Three months of data, were collected and compared with results adjusted for number of patients. The Charlson Comorbidity Index was used as an index of disease severity, and to assess mortality.
RESULTS: We looked at the number of chest xrays ordered per patient stay. In the ICU with limited ultrasound use (for line placement only) there were 5.21 xrays done per patient stay. In the ICU with routine ultrasound there were 1.10 xrays per patient stay. Total CT scans were 0.91 in the non-ultrasound ICU vs. 0.26 per patient stay in the unit that used ultrasound as standard of care. For cardiac echocardiograms in the non-ultrasound ICU there were 0.27 vs. 0.11 in the ultrasound ICU per patient stay. The mortality was 0.27 in the non-ultrasound ICU vs. 0.20 for the ultrasound ICU.
CONCLUSIONS: We found that the use of point of care ultrasound greatly reduces the number of radiological tests ordered without negatively affecting patient outcomes.
CLINICAL IMPLICATIONS: The routine use of point of care ultrasound in a MICU provides the benefits of reducing radiological testing that may have been otherwise ordered and may impact on cost and radiation exposure.
DISCLOSURE: The following authors have nothing to disclose: Margarita Oks, Rubin Cohen, Seth Koenig, Mangala Narasimhan
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