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PoCUS

PoCUS Ultrasound: What is its role in improving healthcare?

As Singapore’s healthcare landscape evolves, innovative technologies that help to improve patient care and clinical outcomes are in high demand. Point-of-care ultrasound (PoCUS) has emerged as a game-changing tool, increasing diagnostic speed and accuracy.

PoCUS empowers medical professionals, including doctors, nurses, and allied health, with real-time imaging capabilities at the patient’s bedside. This ultimately leads to them making informed decisions promptly, with less delay between the onset of symptoms and therapy initiation.

In contrast to a formal ultrasound scan, performed in an imaging department, PoCUS offers a distinct advantage. Its portability saves valuable time, streamlining the path to definitive therapy.

Let’s talk more about PoCUS ultrasound and its role in improving healthcare in the following:

Doctor performing PoCUS ultrasound assessment.

What is PoCUS ultrasound?

Point-of-care ultrasound (PoCUS) refers to bedside ultrasonography performed by attending physicians. PoCUS, which refers to the use of ultrasound by physicians at the point of care, goes beyond the patient’s bedside. It can be performed in any place and condition, including in a clinic, emergency setting, or even in the field.

Unlike a formal ultrasound scan, PoCUS offers a more rapid diagnostic result. As PoCUS ultrasound is portable and can be performed wherever the patient is, results can be determined immediately.

Healthcare professionals such as Emergency Medicine Physicians, Intensivists, Anaesthesiologists, Nephrologists, Respiratory Physicians, Internists, General Practitioners, and other specialists who directly interact with patients can perform PoCUS ultrasound.

The versatility of PoCUS empowers physicians to collect immediate diagnostics to make faster, more informed decisions on the therapy initiations, increasing the overall patient outcomes and ultimately saves lives.

How does PoCUS improve healthcare?

Aside from the convenience of rapid diagnostic imaging, what else can PoCUS do to improve healthcare?

The following are the advantages of PoCUS ultrasound for both physicians and patients:

Accelerates diagnostic decision

PoCUS empowers physicians to visualise patient anatomy in real-time, or immediately at the onset of symptoms. The portable nature of PoCUS machines ensures this practice is readily available at any time. Physicians, whether they are in an Emergency Department, in-patient room, or ICU can swiftly identify any anomalies, injuries, or pathologies that need to be addressed promptly.

Physicians who are well equipped to safely perform PoCUS can answer specific clinical questions related to common patient presentations with ultrasound — enabling more timely and efficient decision making. The PoCUS trained physician understands when to refer for formal imaging and may help to reduce or eliminate further assessment altogether. This helps to reduce patient wait times, streamlines healthcare workflows, and ultimately accelerates diagnosis, which can be lifesaving in the critical ill patient.

Encourages faster therapy initiation

The immediate insights provided by PoCUS enable healthcare teams to deliver faster therapy initiation in a timely manner. This is especially important in critical situations, such as trauma or acute medical conditions, where minutes can make a life-saving difference.

One study (1.) found that PoCUS yields 80% accuracy, whereas examinations without PoCUS result in 50% accuracy. With such a large difference, it demonstrates that PoCUS is an excellent diagnostic tool for providing patients with the appropriate treatments the first time around.

If the physician can more accurately identify pathology and diagnose a patient in their initial consultation, they can accurately on-refer where required, prevent potential complications and initiate a patient treatment as soon as possible – to optimise patient outcomes.

Prevents morbidity and mortality in critically ill patients

Since PoCUS enables physicians with accelerated diagnosis-making and therapy initiation, it serves as a defence against morbidity and mortality in critically ill patients. By continuously monitoring patients and detecting changes in real time, PoCUS assists in the early identification of deteriorating health statuses.

Critically ill patients experiencing sepsis makes one example that PoCUS can help with. PoCUS aids in the prompt diagnosis of such conditions, allowing healthcare providers to intervene proactively and prevent adverse outcomes.

One study (2.) found that using PoCUS ultrasound to aid in clinical decision-making in patients with sepsis was more accurate than relying solely on physical exams and history. This means that the practice has the potential to save lives from the deterioration caused by sepsis, especially given how life-threatening the situation can be.

What are examples of PoCUS ultrasound?

PoCUS helps physicians to make real-time clinical decisions specific to their medical specialty. Given the variety of medical specialities, physicians typically learn to perform PoCUS examinations and protocols that are within the scope of their specialty only. They will later use the imaging results to guide patient management.

The following are some PoCUS ultrasound examples from which physicians can learn and earn credentials as a pathway to competence based on their medical specialities:

AAA Ultrasound

The Abdominal Aortic Aneurysm (AAA) ultrasound visualises the abdominal aorta and assesses its morphology. Physicians perform this as a part of PoCUS to obtain transverse and longitudinal images of the aorta, identifying any abnormalities or aneurysmal changes and perform measurements of the aorta.

Rupture of AAA can be fatal, so early identification of potential AAA using PoCUS can be a life-saving measure performed by physicians, especially if performed as part of a regular screening assessment. Physicians can choose to learn AAA ultrasound to correctly identify AAA on ultrasound imaging to guide patient management.

There are two levels of AAA ultrasound training: Basic and Advanced. Physicians can begin with the basic programme to understand the scanning fundamentals, recognise the aorta and surrounding anatomy, and perform ultrasound of the aorta. AAA Advanced then aims to develop a greater understanding of AAA appearances and how to apply these in clinical management decisions.

DVT Ultrasound

The Deep Vein Thrombosis (DVT) ultrasound analyses the presence of a blood clot that forms in a deep vein. PoCUS can be implemented to visualise the veins in the affected limb and assess the presence of a clot.

The process involves a compression ultrasound technique, which allows physicians to assess the compressibility of the veins. This, in turn, helps them to determine if a clot is present and if blood flow is obstructed.

Physicians can now receive training in order to operate DVT ultrasound efficiently. It consists of DVT Ultrasound Basic and DVT Ultrasound Advanced, which cover all of the fundamentals as well as hands-on practice and clinical case-based discussion to help them excel.

ECHO Ultrasound

Echocardiography, or ECHO for short, is ultrasound performed to visualise the heart’s structures and functions. It is used to assess cardiac anatomy, function, and blood flow.

Using PoCUS as a means of performing ECHO ultrasound empowers physicians to quickly assess heart size, shape, wall size, motion, and valve function as a global cardiac analysis.

The rapid assessment of cardiac function is vital, especially in emergency and critical care settings.

To understand how to obtain and perform the basic views of cardiac ultrasound, physicians need to equip themselves with the necessary skills. Specialised training programmes, such as the Basic Echocardiography in Life Support (BELS) and Critical Care Echo courses, are ideal in this regard to develop the understanding of the anatomy, views, and sonographic appearances of the heart.

The BELS ultrasound course is offered at both basic and advanced levels. Critical Care Echo course, is for the more advanced practitioner to understand more advanced cardiac pathology, and is available in both the basic and advanced programmes.

eFAST Ultrasound

eFAST is a PoCUS protocol used to rapidly assess trauma patients for potential internal injuries, particularly those located in the chest and abdomen. The assessment involves assessment of the heart, lung, pleural spaces, and abdominal cavity to assess for fluid or air.

Physicians can use eFAST to detect the presence of fluid or air (e.g., blood) in the pleural, pericardial, and abdominal spaces, which could indicate internal bleeding or other traumatic injuries. Assessment of the chest can assess for lung aeration, consolidation, or pleural effusion. In this case, prompt identification is critical to preventing internal bleeding from worsening, which can be fatal.

To improve patient outcomes, healthcare professionals can now receive basic and advanced eFAST ultrasound training. The training will provide them with the necessary knowledge and skills to obtain quick and accurate imaging diagnostics to aid in patient management decisions.

Gallbladder and CBD Ultrasound

The Gallbladder and Common Bile Duct (CBD) ultrasound assessment is widely used in a PoCUS setting to investigate causes of right upper quadrant (RUQ) pain. Ultrasound can be performed to assess the presence of cholecystitis, pericholecystic fluid, gallbladder wall inflammation, obstruction of the CBD, and presence of gallstones.

During the course, physicians will gain insights to identify the gallbladder and common bile ducts, recognise signs of inflammation or blockage, measure gallbladder wall, common bile ducts, and other relevant anatomy or pathology. This will allow them to make faster, more informed clinical treatment decisions.

Physicians can now receive Gallbladder and Common Bile Duct ultrasound training to become competent in this practice. The training programme is divided into basic and advanced levels, each of which covers the necessary knowledge and skills.

Lung Ultrasound

PoCUS lung ultrasound is a quick imaging diagnostic that can be performed before proceeding to extensive imaging procedures. Ultrasound can visualise lung and pleural surfaces, consolidation, pneumothorax (collapsed lung), pleural effusion (fluid accumulation between the pleura layers). Ultrasound can also be used as part of interventional procedures such as effusion aspiration, and biopsy as a guide for needle placement.

The rapid imaging information obtained from the PoCUS lung ultrasound is valuable for faster diagnosis-making and monitoring of respiratory issues. This is particularly important in critical or emergency situations where minutes can make a huge difference in saving lives.

To deliver appropriate diagnoses in patients with lung or respiratory issues, physicians need to equip themselves with the required skill sets of performance and understanding of lung ultrasound. They can achieve this by joining dedicated courses in lung: Lung Ultrasound Basic and Lung Ultrasound Advanced.

Both levels can provide the necessary knowledge and hands-on practice in performing lung ultrasound. This can be beneficial before they begin performing imaging diagnostics on patients in real-life scenarios.

Knee Ultrasound

Knee ultrasound provides a rapid examination of the structure within and around the knee joint. This type of PoCUS ultrasound helps healthcare professionals to evaluate injuries or other conditions affecting the knee such as joint effusion, fractures, ligament tears, tendinopathy, or joint inflammation such as synovitis. Ultrasound can also be used in needle guidance for interventional procedures.

Knee ultrasound is particularly useful for assessing sports-related injuries, which are common among athletes. Following the imaging diagnostic, healthcare professionals can decide on therapies that will target the knee joint and help the patient heal.

Health professionals regularly interacting with patients who have sports-related injuries can now gain the essential expertise to perform and interpret knee imaging through knee ultrasound training. The training, coming in basic and advanced levels, empowers them with the skills needed for effective image acquisition and interpretation.

Shoulder Ultrasound

Shoulder ultrasound using the PoCUS technique is now available for rapid imaging of the structures within the shoulder joint, including tendons, muscles, and ligaments. It helps physicians to diagnose various conditions, including rotator cuff injuries, bursitis, effusion, impingement, as well as assessment of dislocation and fractures.

The swift imaging diagnostic of shoulder ultrasound makes it an efficient way to assess the source of shoulder pain experienced by the patient. This leads to physicians being able to make faster treatment decisions and help the patient recover effectively.

Given the importance of PoCUS shoulder ultrasound in guiding patient management of shoulder issues, physicians can now get the necessary training. Shoulder ultrasound basic and advanced training is an ideal choice in this case, as it provides them with fundamentals and ample hands-on practice for real world application.

Renal Tract Ultrasound

Renal tract ultrasound, or kidney ultrasound, is another type of PoCUS ultrasound performed to examine the kidneys, ureters, and bladder. It aids physicians in determining kidney and bladder size, shape, and the presence of abnormalities such as hydronephrosis, obstruction, bladder size, wall abnormalities, stones, renal cysts, and tumours.

With its rapid imaging diagnostic capabilities, PoCUS for renal tract ultrasound is useful for monitoring kidney-related issues in a variety of clinical settings. This is especially useful when the patient will benefit from prompt recovery management.

Physicians can now equip themselves to operate the PoCUS renal tract ultrasound through dedicated courses. Renal Ultrasound Basic and Renal Ultrasound Advanced are two prerequisite training courses that better prepare them to work on real-world cases.

The importance of PoCUS credentials

PoCUS credentials demonstrate that physicians are capable of performing imaging diagnostics and interpreting results in the clinical setting.

With PoCUS credentials, physicians focus on becoming skilled users of point of care ultrasound machines, especially those suited to their clinical setting. The programme enables them to promptly address patients in need of rapid imaging diagnostics before determining the need for further evaluation. This develops the understanding of when to on-refer for more formal medical imaging such as a formal ultrasound, X-ray, or CT.

Final thoughts

The innovation of PoCUS ultrasound empowers physicians to provide rapid imaging diagnostics and quickly determine therapy for patients in need.

PoCUS ultrasound includes a broad spectrum of evaluations to include the abdomen, heart, and lungs, as well as assessment of soft tissue, veins, arteries, bone, and joints such as knee and shoulder. With the complexity of anatomy and pathology in these areas, physicians must possess the skills to perform PoCUS when attending to patients, especially in crucial situations where minutes hold significance in saving lives.

Learn PoCUS ultrasound and earn your AIU-NUS credentials today!

AIU, in partnership with NUS, is now providing AIU-NUS Credentialed Courses designed for medical and allied healthcare professionals. The courses prepare healthcare professionals like you to become proficient in using PoCUS ultrasound devices for effective patient management.

A range of credentialed courses are also available for enrolment via the SkillsFuture Courses programme for eligible doctors.

Take this as your chance to contribute to enhancing patient outcomes and advance your career within the healthcare field! Contact us for further information.

References:

  1. Berg, I., Walpot, K., Lamprecht, H., Valois, M., Lanctôt, J. F., Srour, N., & van den Brand, C. (2022). A Systemic Review on the Diagnostic Accuracy of Point-of-Care Ultrasound in Patients With Undifferentiated Shock in the Emergency Department. Cureus, 14(3), e23188. https://doi.org/10.7759/cureus.23188
  2. Alonso, J. V., Turpie, J., Farhad, I., & Ruffino, G. (2019). Protocols for Point-of-Care-Ultrasound (POCUS) in a Patient with Sepsis; An Algorithmic Approach. Bulletin of emergency and trauma, 7(1), 67–71. https://doi.org/10.29252/beat-0701010