POCUS, CHANGING THE PATIENT CARE

Paulo Mottin Rosa, MD/Hospitalist, Marcio Spagnol, MD, Sofia Kuhn, MD, Josiane John, MD, MSc, Lana Pinto, MD, Msc, Hospital Nossa Senhora da Conceição

Meeting: Hospital Medicine 2018; April 8-11; Orlando, Fla.

Abstract number: 251

Categories: Hospital Medicine 2018, Innovations, Quality Improvement

Keywords: , , ,

Background: Ultrasonography has been used for the last decades as a diagnostic tool. In recent years has been used in internal medicine at the bedside as a safe method that can easily detect abnormalities and provides immediate feedback.

Purpose: Describe the Point of Care Ultrasound (POCUS) that has been made in an Internal Medicine Department between March and November of 2017. Review patients characteristics, conditions that lead to exam and if the abnormalities seen in POCUS lead to any change in-patient care (which means: a new therapy was initiated, dose adjustment was made or a procedure, an exam or an expert opinion was requested because of abnormalities seen in POCUS). These data was available in electronic forms filled by the faculties who made POCUS at patients in Internal Medicine Department. Experts in POCUS previously trained all of these faculties. The ethical committee of the institution approved this project.

Description: Between March and November of 2017 257 POCUS in 200 patients were made and had electronic form filled adequately. The mean age was 66,24 (±16,3). The mean Charlson Comorbidity Index was 6,15 (±3,3), 158 patients (79% of patients) had Charlson Comorbity Index of four or more, 99 patients were male and 101 were female.In total 310 different systems were evaluated (more than one could be evaluated in the same patient), 210 evaluated the lungs (82% of patients), 46 the heart (18% of patients), 39 the abdomen (15% of patients), 12 vascular system (0,05% of patients) and 3 evaluated other parts of the body (0,01% of patients).
About the condition that lead to use of POCUS (more than one condition could be present in the same patient), in 125 were dyspnea (49% of patients), 98 were presence of free fluid – ascites or pleural effusion (38% of patients), 79 were to asses volume status (31% of patients), 22 were to asses source of infection (0,09% of patients), 10 were to evaluated venous thrombosis (0,04% of patients), 1 was to asses cause of shock (0,004% of patients) and 4 to other reasons (0,02% of patients).
In 149 patients POCUS has changed patient care (55% of patients), in 74 patients diagnosis ultrasonography maybe has changed patient care – there was no active change in care, but the exam rule out differential diagnosis (29% of patients) and in 41 patients diagnosis ultrasonography has not changed patient care (16% of patients).

Conclusions: The best care to patients should be easily and safely, in these context POCUS may be considered as part of physical examination. In our Internal medicine department, POCUS active changed of care in 55% of patients, when demanded, demonstrating that ultrasonography is useful to help clinical judgment. More important, in 29% of patients ultrasonography ruled out differential diagnosis, probable preventing use of other therapy that could be harmful.

To cite this abstract:

Mottin Rosa, P; Spagnol, M; Kuhn, S; John, J; Pinto, L. POCUS, CHANGING THE PATIENT CARE. Abstract published at Hospital Medicine 2018; April 8-11; Orlando, Fla. Abstract 251. https://www.shmabstracts.com/abstract/pocus-changing-the-patient-care/. Accessed December 6, 2019.

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