Hand-carried echocardiography fails to reduce length of hospital stay
MedWire News: Implementing hospitalist care guided by a hand-carried echocardiography does not meaningfully affect the length of hospital stay for unselected general medicine patients, report US researchers.
"The projected role of hand-carried echocardiography is not to replace state-of-the-art echocardiography but instead to precede and, in some cases, obviate it with simple and routine assessments by front-line physicians," they write in the American Journal of Medicine.
However, the team's findings did not show any significant different reduction in mean length of stay after use of the hand-carried device versus usual care, neither can they be used to infer possible effects on care quality.
Brian Lucas (Stroger Hospital of Cook County and Rush Medical College, Chicago, Illinois) and colleagues randomly assigned 226 adult general medicine inpatients with an indication for echocardiography to investigation with the hand-carried device, and 227 similar patients to usual care with a standard echocardiography.
Of patients assigned to the hand-carried device, hospitalists performed echocardiography a median 16 hours after admission to hospital, and took a median 10 minutes to perform it.
Overall, the difference in length of hospital stay under the appointed hospitalist's care was not significantly reduced in the hand-carried echocardiography group compared with the usual care group, at 46.1 hours versus 46.9 hours, respectively. The nonsignificant difference remained when 40 patients referred to other services before discharge were excluded from the analysis.
In the patients who underwent hand-carried echocardiography and subsequent standard echocardiography for confirmation of results, hospitalists changed the management of their care due to the hand-carried device in 37% of cases.
While diagnostic performance varied according to the abnormality being investigated, indeterminate results only occurred in 3-10% of assessments using the hand-carried device.
Hospitalists regarded the hand-carried devices to be "importantly mistaken" (ie, they gave importantly different results from standard echocardiography testing) in 12% of participants.
Standard echocardiography also uncovered abnormalities not seen with the hand-carried echocardiography in 89% of patients, however, hospitalists deemed these important in only 6% of cases, say Lucas et al.
"Despite the favorable diagnostic performance of hand-carried echocardiography, hospitalists awaited standard echocardiography results before planning hospital discharge for most participants," they add.
A limitation of the study meant that investigators were not available around the clock and this led to a delay in the performance of hand-carried echocardiography by a median of 16 hours after admission, write the study authors.
"If hand-carried echocardiography had been performed at admission, it may have made more of an impact," they conclude.
By Sarah Guy