Point-of-Care Ultrasonography for Primary Care Physicians and General Internists.
Point-of-care ultrasonography (POCUS) is a safe and rapidly evolving diagnostic modality that is now utilized by health care professionals from nearly all specialties. Technological advances have improved the portability of equipment, enabling ultrasound imaging to be executed at the bedside and thereby allowing internists to make timely diagnoses and perform ultrasound-guided procedures. We reviewed the literature on the POCUS applications most relevant to the practice of internal medicine. The use of POCUS can immediately narrow differential diagnoses by building on the clinical information revealed by the traditional physical examination and refining clinical decision making for further management. We describe 2 common patient scenarios (heart failure and sepsis) to highlight the impact of POCUS performed by internists on efficiency, diagnostic accuracy, resource utilization, and radiation exposure. Using POCUS to guide procedures has been found to reduce procedure-related complications, along with costs and lengths of stay associated with these complications. Despite several undisputed advantages of POCUS, barriers to implementation must be considered. Most importantly, the utility of POCUS depends on the experience and skills of the operator, which are affected by the availability of training and the cost of ultrasound devices. Additional system barriers include availability of templates for documentation, electronic storage for image archiving, and policies and procedures for quality assurance and billing. Integration of POCUS into the practice of internal medicine is an inevitable change that will empower internists to improve the care of their patients at the bedside.
Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN. Electronic address: bhagra.anjali@mayo.edu.
Anjali
A
Bhagra
Abbott Northwestern Hospital, Medical Education Department, Minneapolis, MN.
David M
DM
Tierney
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
Hiroshi
H
Sekiguchi
Section of Hospital Medicine, South Texas Veterans Health Care System and Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health Science Center, San Antonio, TX.
Nilam J
NJ
Soni
D003422:Critical Care / Q000379:methods*; D004501:Education, Medical / Q000458:organization & administration; D006333:Heart Failure / Q000000981:diagnostic imaging*; D006801:Humans; D007362:Intensive Care Units; D019095:Point-of-Care Systems / Q000458:organization & administration*; D018805:Sepsis / Q000000981:diagnostic imaging*; D014218:Triage / Q000458:organization & administration; D014463:Ultrasonography / Q000379:methods*