Alexander Bonnel, Bruce Kinosian, Nova Panebianco, Paul Wallace, Cameron Baston

LEARNING OBJECTIVE

To assess the utilization of a handheld ultrasound (HUS) in the home visit setting and its impact on clinical decisions made by geriatricians caring for home-limited patients.

AIM

While physician performed point-of-care ultrasound (POCUS) is relatively common practice in parts of Europe, home care visits and internal medicine (IM) use of POCUS is fairly novel in the United States (U.S.).

It is unknown what POCUS exams are most clinically relevant or how POCUS can impact home care delivery in the U.S. population.

The goal of this pilot was to assess the utilization of a handheld ultrasound (HUS) in the home visit setting and its impact on clinical decisions made by geriatricians caring for home-limited patients.

METHODS

A multidisciplinary team comprised of an IM POCUS fellow and a geriatrician performed home visits in a large U.S. city.

All patients were home-limited and unable to easily be transported for outpatient appointments or imaging diagnostics.

Patients with an acute complaint or clinical question that could be assessed with HUS were identified by the geriatrician and discussed with the POCUS fellow prior to the home visit.

All HUS exams were performed on a handheld device interpreted in real time by the fellow, and findings were discussed with the care team.

Limited patient history, clinical findings, and images were stored in a secure database/server for asynchronous review. This study was approved by the Institutional Review Board.

RESULTS

Over a 4-month period, 13 patients were evaluated during 18 home visits.

The most frequent exams performed were lung (17), inferior vena cava (16), cardiac (9), bladder (5), and internal jugular vein for jugular venous pressure estimation (3).

The most frequent indications for HUS were assessment of intravascular volume status (11), dyspnea/hypoxia (2), and evaluation for urinary retention (2).

In 10/18 (55%) visits, the patient’s care plan was changed as a result of the HUS findings in conjunction with other relevant clinical data. Changes included discontinuation of IV diuresis, oral diuretic dosage adjustments, and the initiation of home IV diuretic dosing.

One patient was admitted for expedited workup of a clinically occult unilateral pleural effusion identified on ultrasound.

On one patient, HUS findings were interpreted as pulmonary edema because of a diffuse b-line pattern however was ultimately diagnosed with interstitial lung disease.

CONCLUSIONS

This pilot study demonstrates the most prevalent themes in HUS use during geriatric home visits.

HUS findings affected clinical care in over half of the patient encounters and had the greatest impact in diuretic management.