title: Hand-carried echocardiography by hospitalists: a randomized trial.
abstract: BACKGROUND
  Hospitalists can use hand-carried echocardiography for accurate point-of-care information, but patient outcome data for its application are sparse.
  
  
  METHODS
  We performed an unblinded, parallel-group randomized trial between July 2008 and March 2009 at one teaching hospital in Chicago, Illinois. We randomly assigned adult general medicine inpatients referred for standard echocardiography with indications investigatable by hand-carried echocardiography to care guided by hand-carried echocardiography or usual care. The main outcome measure was length of stay on the referring hospitalist's service. Secondary outcomes included a before-after analysis of reported changes in management due to hand-carried echocardiography and the diagnostic accuracy of hand-carried echocardiography.
  
  
  RESULTS
  The difference in length of stay between 226 participants randomized to care guided by hand-carried echocardiography (geometric mean 46.1 hours, interquartile range 29.0-70.9 hours) and 227 participants randomized to usual care (46.9 hours, interquartile range 34.1-68.3 hours) corresponded to a 1.7% reduction in length of stay that was not statistically significant (95% confidence interval, -12.1 to 9.8%). In post hoc subgroup analyses, care guided by hand-carried echocardiography reduced length of stay in participants who were referred for heart failure (P=.0008). Among participants who underwent both hand-carried and standard echocardiography, hospitalists changed management due to hand-carried echocardiography in 37%. Despite the favorable diagnostic accuracy of hand-carried echocardiography, most changes to the timing of hospital discharge occurred after standard echocardiography.
  
  
  CONCLUSIONS
  Hospitalist care guided by hand-carried echocardiography for unselected general medicine patients does not meaningfully affect length of stay. Whether or not it affects care quality remains unstudied.
authors.affiliation: Department of Medicine, Stroger Hospital of Cook County and Rush Medical College, Chicago, IL, USA. brian_lucas@rush.edu
authors.forename: Brian P
authors.initials: BP
authors.lastname: Lucas
authors.forename: Carolina
authors.initials: C
authors.lastname: Candotti
authors.forename: Bosko
authors.initials: B
authors.lastname: Margeta
authors.forename: Benjamin
authors.initials: B
authors.lastname: Mba
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kumapley
authors.forename: Abdo
authors.initials: A
authors.lastname: Asmar
authors.forename: Ricardo
authors.initials: R
authors.lastname: Franco-Sadud
authors.forename: Joshua
authors.initials: J
authors.lastname: Baru
authors.forename: Christine
authors.initials: C
authors.lastname: Acob
authors.forename: Shane
authors.initials: S
authors.lastname: Borkowsky
authors.forename: Arthur T
authors.initials: AT
authors.lastname: Evans
mesh_terms: D000368:Aged; D002641:Chicago / Q000453:epidemiology; D015986:Confounding Factors, Epidemiologic; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000706:statistics & numerical data*; D004867:Equipment Design; D005260:Female; D020445:Hospitalists; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*