Persistently increasing healthcare spending, paired with growing healthcare demand, highlights the need to identify mechanisms for cost savings. Chest radiography (CXR) is commonly performed following intrathoracic procedures to rule out pneumothorax (PTX) even if the clinical pretest probability is low. However, lung ultrasound (LUS) is known to have superior sensitivity, possibly representing a promising cost-saving tool. In response, we conducted an economic analysis comparing LUS and CXR to exclude PTX after invasive intrathoracic procedures.

A retrospective review of the radiology case-costing center was performed at an academic cardiothoracic surgical institution to identify the activity and cost of CXRs performed to rule out PTX following intrathoracic procedures. This cost was then compared to the theoretical cost of LUS.

CXRs performed to rule out iatrogenic PTX were common with 22,274 radiographs completed and were economically burdensome, with an associated cost of $1.4 million. Portable CXR cost $75.46 per test, while CXR posteroanterior/lateral costs $41.64. Comparatively, LUS cost $38.38. Implementation would lead to cost savings of $559,537.10 or $41.58, on average, per patient.

Given the superiority of LUS in terms of sensitivity and accuracy for PTX diagnosis, these findings underscore the compelling rationale for its broader integration into clinical practice.

Point-of-care ultrasound (POCUS) enhances diagnostic accurate, reduces time to diagnosis, and improves patient satisfaction. Competenties encompass indications, image acquisition, interpretation, and medical decision-making. Education involves didactic methods and hands-on practice with emphasis on longitudinal training and feedback. Assessment tools target knowledge, psychomotor, attitudinal domains. POCUS portfolios and quality assurance ensure competence and continued overarching POCUS oversight and feedback. Scan numbers are often used as a surrogate for competency; however, it is important to note that learning curves vary by POCUS application. Proper POCUS use requires understanding its diagnostic power and potential limitations. POCUS indications vary by clinical scenarios and beneficial applications for training and credentialing vary by medical niche. This text underscores the importance of standardized training and evidence-based practices in POCUS utilization.

Point-of-care ultrasonography (POCUS), particularly venous excess ultrasound (VExUS) is emerging as a valuable bedside tool to gain real-time hemodynamic insights. This modality, derived from hepatic vein, portal vein, and intrarenal vessel Doppler patterns, offers a scoring system for dynamic venous congestion assessment. Such an assessment can be crucial in effective management of patients with heart failure exacerbation. It facilitates diagnosis, quantification of congestion, prognostication, and monitoring the efficacy of decongestive therapy. As such, it can effectively help to manage cardiorenal syndromes in various clinical settings. Extended or eVExUS explores additional veins, potentially broadening its applications. While VExUS demonstrates promising outcomes, challenges persist, particularly in cases involving renal and liver parenchymal disease, arrhythmias, and situations of pressure and volume overload overlap. Proficiency in utilizing spectral Doppler is pivotal for clinicians to effectively employ this tool. Hence, the integration of POCUS, especially advanced applications like VExUS, into routine clinical practice necessitates enhanced training across medical specialties.

Purpose Handheld ultrasound (HH-US) answers simple clinical questions in emergencies. We performed conventional US with HH-US at the patient's bedside (BED) during a medical visit (MED) (BED MED-US). The purpose of this prospective study is to estimate BED MED-US reliability, its clinical impact in helping the clinician to formulate correct diagnoses, and its ability to save time and money. Materials and Methods 1007 patients (519 M; age:76.42) were assessed (from March 2021 to November 2022) in one or more districts. Final diagnosis was determined with clinical and reference tests (chest RX/CT, abdominal CT, endoscopy, etc.). Sensitivity, specificity, LR+ and LR-, and corresponding AUROC were evaluated. HH-US diagnoses were classified as: confirmation (HH-US revealed the sonographic signs that confirmed the clinical diagnosis) (CO), exclusion (HH-US excluded the presence of the ultrasound signs of other pathologies, in the clinical differential diagnosis) (EX), etiological (HH-US reaches diagnosis in clinically doubtful cases) (ET), or clinically relevant incidental (HH-US diagnoses that change the patient's process completely) (INC). Results HH-US reliability: true-pos: 752; true-neg: 242; false-pos: 7; false-neg: 6 (sens: 99.1%, spec: 97.6%, LR+: 98.5; LR-: 00.15, AUROC: 0.997); clinical impact: CO-diagnosis: 21%; EX: 25%; ET: 47%; INC: 7%; saved time and money: approximately 35,572 minutes of work and 9324 euros. Conclusion BED MED-US is a reliable clinical imaging system, with an important clinical impact both in diagnosis (etiological in 47%, incidental in 7%) and in the management of personnel resources.

Point of care ultrasonography (POCUS) is emerging as an invaluable tool for guiding patient care at the bedside, providing real-time diagnostic information to clinicians. Today, POCUS is recognized as the fifth pillar of bedside clinical examination, alongside inspection, palpation, percussion, and auscultation. In spite of growing interest, the adoption of diagnostic POCUS in nephrology remains limited, and comprehensive training beyond kidney ultrasound is offered in only a few fellowship programs. Moreover, several misconceptions and barriers surround the integration of POCUS into day-to-day nephrology practice. These include myths about its scope, utility, impact on patient outcomes and legal implications. In this minireview, we address some of these issues to encourage wider and proper utilization of POCUS.

Point-of-care ultrasonography (POCUS) is being increasingly recognized as an adjunct to physical examination. However, limited availability of trained faculty in specialties other than emergency medicine and lack of universal training standards remain key barriers to its widespread integration into undergraduate and graduate medical curricula. In this study, we sought to explore the effectiveness of a short simulation-based workshop for medical students teaching basic cardiac ultrasound led by a nephrologist.

Workshops were conducted for 2 different groups of 4th-year medical students with a total of 25 attendees. The workshop consisted of a 1-hour lecture followed by 15 minutes of cardiac anatomy simulation and a 2- to 2.5-hour hands-on session in the simulation laboratory. An anonymous precourse questionnaire comprising 10 questions assessing the interpretation of common grayscale ultrasound findings encountered in patients with undifferentiated hypotension was performed. After the workshop, a postcourse exam and survey were conducted, retesting the same concepts and seeking the students' feedback on the course.

In total, 23 and 20 students answered the pre- and postcourse surveys, respectively. The mean total score on the pretest was 63.8% ± 13.6%, which significantly increased to 91.5% ± 10.5% on the posttest (P < .001). About 90% of the respondents strongly agreed that the cardiac anatomy simulation improved their understanding of the cardiac sonographic anatomy; 75% strongly agreed that the hands-on simulation enhanced their confidence in image acquisition and interpretation; and 70% said they would choose nephrology elective if POCUS training was integrated with it.

A nephrologist-led diagnostic POCUS workshop using simulation techniques is effective in improving the learners' knowledge, understanding of the sonographic cardiac anatomy, and confidence in image acquisition. Integration of POCUS training may increase medical student interest in nephrology elective rotations.

Point-of-care ultrasound (PoCUS) has been recognised as a tool that leads to more definitive diagnoses and enhances clinical decision-making in rural emergency departments (EDs) where diagnostic imaging is limited. We aimed to determine the current utilisation, barriers and solutions to using PoCUS in this rural Saskatchewan ED.

Physicians working in the ED participated in a semi-structured interview. An online survey, administered via SurveyMonkey post-interview to provide further context, was used to support qualitative approaches. Interviews were recorded, transcribed and then analysed using inductive interpretation.

Seven physicians completed the quantitative survey with a response rate of 70%. Ten physicians were interviewed with a response rate of 100%. Themes identified were that physicians in this community's ED perceived their skill level as determining whether a scan was diagnostic or not, rather than the specific PoCUS application itself. In addition, they performed scans primarily for the purpose of triage. Inadequate training, Core IP certification certification requirement and intradepartmental logistics were barriers to PoCUS utilisation.

This study showed that ED physicians in this community perceived PoCUS as a clinical adjunct and as a tool to triage patients for further imaging. Results highlight the need to have accessible training for rural physicians to increase PoCUS utilisation, awareness of current Saskatchewan PoCUS guidelines and education on diagnostic applications of PoCUS. Increased use of PoCUS for specific scans could decrease the need for formal imaging and the associated healthcare system resources.

Point-of-care ultrasound (POCUS) has been adopted as a powerful tool in acute medicine. This systematic review aims to critically appraise the existing literature on point-of-care ultrasound in respiratory or circulatory deterioration.

Original studies on POCUS and dyspnea, nontraumatic hypotension, and shock from March 2002 until March 2022 were assessed in the PubMed and Embase Databases. Two reviewers independently screened articles for inclusion, extracted data, and assessed the quality of included studies using an established checklist.

We included 89 articles in this review. Point-of-care ultrasound in the initial workup increases the diagnostic accuracy in patients with dyspnea, nontraumatic hypotension and shock in the ED, ICU and medical ward setting. No improvement is found in patients with severe sepsis in the ICU setting. POCUS is capable of narrowing the differential diagnoses and is faster, and more feasible in the acute setting than other diagnostics available. Results on outcome measures are heterogenous. The quality of the included studies is considered low most of the times, mainly because of performance and selection bias and absence of a gold standard as the reference test.

We conclude that POCUS contributes to a higher diagnostic accuracy in dyspnea, nontraumatic hypotension, and shock. It aides in narrowing the differential diagnoses and shortening the time to correct diagnosis and effective treatment.

INPLASY; Registration number: INPLASY202220020; URL: https://inplasy.com/.

The aim in this systematic review was to determine the effect of point-of-care ultrasound (POCUS) on the clinical decision-making process and patient outcomes in adults admitted to the general medicine ward. A comprehensive search was performed in MEDLINE (Ovid), EMBASE (Ovid), PubMed, the Cochrane Library, ClinicalTrials.gov, Scopus, LILACS and Cinahl. Articles had to fulfill the inclusion criteria of randomised or non-randomised studies assessing the impact of POCUS on the diagnosis, management, length of hospital stay or mortality of patients admitted to the internal medicine ward. Six studies were included involving a total of 1836 patients. The influence of POCUS on the diagnosis was reported as a change in the main diagnosis or the addition of a relevant diagnosis in up to 18% and 24% of the cases, respectively. Impact on the management plan was reported in 37% to 52.1% of the participants. Three studies documented the impact of POCUS on the length of stay. Two of them reported no difference between groups, and the other reported a significant reduction of 1 d of the hospital stay. In conclusion, POCUS appears to have positive effects on the clinical decision-making process with impacts on optimal patient management and possible reduction in the hospital length of stay.

Point-of-care ultrasonography (POCUS) is a limited ultrasound study performed by the clinician at the bedside as a component or an adjunct to physical examination. POCUS has multiple applications in nephrology practice, including evaluation of obstructive uropathy, objective assessment of volume status, arteriovenous access assessment, and procedural guidance. However, unlike specialties such as emergency medicine, POCUS training is not yet integrated into most nephrology fellowship curricula, and the sonographic applications taught vary widely among fellowship programs. In this article, we have used our institutional experience to provide a roadmap or blueprint for nephrology programs looking to create a POCUS program. We provide an overview of the curriculum, including the basic organization, applications taught, online resources, milestone development, and quality assessment. We also discuss the nuances of POCUS workflow and perspectives on billing for these limited studies. In addition, we share the evaluation forms and sample documentation we use in our program. Future support, in the form of endorsed nephrology society guidelines, is needed before POCUS training is universally incorporated across nephrology fellowship programs.

Point-of-care ultrasound (POCUS) is a widely used diagnostic modality in the emergency physician's tool kit. The effect on health care costs is disputed. This study examined whether POCUS was associated with system-level cost savings. Secondary objectives included adverse patient outcomes and the association between POCUS use and diagnostic costs in specific patient groups.

The Point-of-Care Ultrasound Use and Monetary Outcomes study was a single-center prospective observational study. A convenience sample of emergency medicine physicians working from July to October 2019 were included after using POCUS as part of their assessment. The cost of patient investigations was compared with those proposed by a control group of physicians simultaneously on shift, who were blinded to the POCUS findings. Ethical approval was obtained from the Queen's University Health Sciences Research Ethics Board.

Fifty patient assessments using POCUS were included. Overall, the median investigation cost in United States dollars in the POCUS group was $102.00 (interquartile range [IQR], $39.80-$167.90) versus $122.40 (IQR, $70.96-$175.60) in controls (P = .08). When stratified by disposition, POCUS use in patients discharged home resulted in a median expenditure of $71.80 (IQR, $36.48-$116.70) versus $122.70 (IQR, $71.18-$183.20; P < .001). Significant cost savings were also found in flank pain presentations (median, $138.90; IQR, $136.60-$186.10; P = .01). There were no differences in the quantity of investigations ordered, the patient emergency department repeated presentation rate, or safety outcomes at 7 days.

Point-of-care ultrasound use was not associated with significant cost savings in our overall population. The subgroup analysis revealed significant POCUS-associated cost savings in patients discharged home and those presenting with flank pain. Notably, POCUS was not associated with an increase in adverse patient safety outcomes.

Point-of-care ultrasonography (POCUS) has evolved as a valuable adjunct to physical examination in the recent past and various medical specialties have embraced it. However, POCUS training and scope of practice remain relatively undefined in nephrology. The utility of diagnostic POCUS beyond kidney and vascular access is under-recognized. Assessment of fluid status is a frequent dilemma faced by nephrologists in day-to-day practice where multiorgan POCUS can enhance the sensitivity of conventional physical examination. POCUS also reduces fragmentation of care, facilitates timely diagnosis, and expedites management. Although the need for further imaging studies is obviated in selected patients, POCUS is not meant to serve as an alternative to consultative imaging. In addition, the utility of POCUS depends on the skills and experience of the operator, which in turn depend on the quality of training. In this review, we discuss the rationale behind nephrologists performing POCUS, discuss patient examples to illustrate the basic principles of focused ultrasonography, and share our experience-based opinion about developing a POCUS training program at the institutional level.

Point-of-care ultrasonography (POCUS) is rapidly evolving as a noninvasive adjunct to physical examination among various specialties. POCUS increases the sensitivity of conventional physical examination by providing the answers to simple clinical questions at the bedside. As such, it can reduce fragmentation of care and expedite management. In addition, using bedside ultrasound as the first-line investigation may eliminate unnecessary radiation and contrast exposure. The advent of highly portable and affordable ultrasound devices has made the use of POCUS more practical and user-friendly, making it the stethoscope of the 21st century. This review will provide an overview of the rationale for integrating POCUS into nephrology practice. We also discuss the current scope of POCUS practice and state of training.