title: The use of hand-carried ultrasound in the hospital setting--a cost-effective analysis.
abstract: OBJECTIVE
  We sought to assess the accuracy of hand-carried ultrasound (HCU) in the prediction of a normal study, and its cost-effectiveness in reducing the number of standard departmental echocardiograms (SDE) performed on hospital inpatients.
  
  
  METHODS
  The setting was a district general hospital. Participants were 157 consecutive inpatients, mean age 68 (range: 18-97) years, 95 men (61%), referred for SDE. HCU was performed at the bedside as part of the clinical assessment. SDE was performed routinely. Main outcome measures were: (1) assessment of the accuracy of HCU in detection of a normal or abnormal study as determined by SDE; and (2) a cost-effectiveness analysis.
  
  
  RESULTS
  Indications for echocardiography were: left ventricular (LV) function assessment, n = 101 (64.3%); valvular abnormalities, n = 11 (7%); arrhythmia, n = 4 (2.6%); miscellaneous, n = 10 (6.4%); and no reason stated, 31 (19.7%). The sensitivity, specificity, and positive and negative predictive values of HCU predicting a completely normal scan were 74%, 96%, 94%, and 81%, respectively, and of predicting normal LV function in requests specific for LV function assessment were 81%, 100%, 100%, and 77%, respectively. If either all inpatients or those with requests for LV function assessment underwent HCU initially, and only those with abnormal scans underwent further SDE, there would be a 29% and 22% reduction in departmental workload and a cost saving of pound sterling 23,000 and pound sterling 30,000, respectively.
  
  
  CONCLUSIONS
  HCU is an accurate method of identifying patients with normal hearts as determined by SDE. Its routine use is cost-effective and can significantly reduce the number of SDE that need be performed.
authors.affiliation: Department of Cardiology, Northwick Park Hospital, London, United Kingdom.
authors.forename: Kim
authors.initials: K
authors.lastname: Greaves
authors.forename: Paramjit
authors.initials: P
authors.lastname: Jeetley
authors.forename: Michael
authors.initials: M
authors.lastname: Hickman
authors.forename: Girish
authors.initials: G
authors.lastname: Dwivedi
authors.forename: Nikant
authors.initials: N
authors.lastname: Sabharwal
authors.forename: Tiong
authors.initials: T
authors.lastname: Lim
authors.forename: Rajesh
authors.initials: R
authors.lastname: Janardhanan
authors.forename: Roxy
authors.initials: R
authors.lastname: Senior
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D004452:Echocardiography / Q000191:economics* / Q000295:instrumentation / Q000706:statistics & numerical data*; D004867:Equipment Design; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000191:economics* / Q000379:methods* / Q000706:statistics & numerical data; D012307:Risk Factors; D012680:Sensitivity and Specificity; D006113:United Kingdom / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000191:economics* / Q000453:epidemiology; D016526:Workload / Q000191:economics / Q000706:statistics & numerical data