Handheld Ultrasound Practice Areas | Vscan Connections

Handheld Ultrasound Practice Areas

Handheld Ultrasound Practice Areas.

How a Handheld Ultrasound Exam Could Help in Three Scenarios

The handheld ultrasound exam offers incredible potential for today's primary care physicians (PCPs) — it can, and should, be used as a key diagnostic tool. According to a study in The World Book of Family Medicine, "Ultrasonography should be a diagnosis tool beside the stethoscope in the general practitioner office ... the two instruments should be considered as complementary."

Further, a study in PLoS One identified that "after a simple and short training course, a pocket-sized ultrasound device examination can be used in addition to a physical examination to improve the answer to ... common clinical questions concerning in- and outpatients and can reduce the need for further testing."

Specifically, a focused ultrasound exam may be used to complement the PCP's physical examination in three common diagnostic areas: right upper quadrant pain; flank pain; and deep vein thrombosis (DVT).

Right Upper Quadrant Pain
Right upper quadrant pain is a common presentation in primary care. The handheld ultrasound exam of the right upper quadrant of the abdomen can look for signs of gross abnormalities of the liver and gallbladder.

Point of care ultrasound may be used to identify the presence of gallstones and to assess for acute cholecystitis by detecting Murphy sign, anterior gallbladder wall thickening and pericholecystic fluid. The handheld ultrasound may also be used to assess potential bile obstruction by measuring the common bile duct diameter. This may help the physician pursue non-gallbladder sources of epigastric discomfort.

Flank Pain
When it comes to flank pain, a handheld ultrasound device may be used to assess the kidneys and, specifically, to look for hydronephrosis, identify renal or ureteral stones and to check the post-void residual bladder volume. This may provide a physician with more context in relation to the physical exam.

A study in Urology noted that a urologist "using handheld-pocket-size device is equivalent to a sonographist-performed ultrasound study using a standard device in most parameters examined. The handheld device can be used in evaluating the upper and lower urinary tract with the exception of renal masses and therefore can be of great assistance in a wide variety of the daily urological practice scenarios."

Deep Vein Thrombosis
There is a potential benefit in using handheld ultrasound devices when dealing with DVT. According to the Journal of the American College of Cardiology: Cardiovascular Imaging, "The accurate and immediate decision-making allowed by the pocket-size ultrasound examination (PUE) has the potential to exert a significant impact on the current diagnostic strategies for DVT. Positive PUE can make other diagnostic or therapeutic procedures available earlier for the patient without standard ultrasound examination."

Handheld ultrasound devices can potentially allow physicians to scan anyone suspected of having DVT without them having to wait for blood test results. A paper in Thrombus stated that "reducing the time to diagnose DVT could potentially avoid the use of self-injected low molecular weight heparin by patients."

Training for Success
As with any technology, getting the proper training is a key component for reaching positive results. An article in the Annals of Internal Medicine encourages "residency training programs to teach PoCUS, practicing hospitalists to incorporate it into daily practice, and hospitals and hospital medicine programs to provide easy access to the necessary technology."

A study in BMC Medical Education concluded that "medical students with minimal training were able to use (a pocket-size imaging device) as a supplement to standard physical examination and successfully acquire acceptable relevant organ images for presentation and correctly interpret these with great accuracy." And, according to the Annals of Internal Medicine study, the "use of ultrasound by hospitalists will continue to modernize the bedside evaluation and streamline the diagnostic process."

By adding handheld ultrasound to the routine examination, PCPs may have the potential to reduce waiting times and ultimately deliver better care to those who need it.
>Read more

Technology and Innovation. Handheld Ultrasound Practice Areas.

Building the Doctor-Patient Relationship With Practical Visualization Tools

The doctor-patient relationship relies on strong communication, just like every other relationship in healthcare. Between providers, communication failure, not a lack of provider skill, has been identified as the root cause of approximately 80 percent of serious adverse events in healthcare settings. The implications of failures in doctor-patient communications should be taken just as seriously.

Medical schools are stepping up to the plate and putting more emphasis on relationships and communication, but more practical steps are needed. Thankfully, a new class of portable tools is emerging to address those gaps.

Better Outcomes Start With Physician Empowerment
Often, the discussion around outcome improvement centers on patient empowerment. Of course, patient-centered health matters, but a large portion of it rests in the hands of physicians.

Physicians have an amazing opportunity to be catalysts in revolutionizing the patient experience, simply by being willing and enthusiastic agents of patient empowerment.

At the same time, the benefits of an improved doctor-patient relationship flow both ways. Having confused, irritated patients might lead to poor outcomes, which may directly impact a physician's feelings of job fulfillment — a dynamic that can't be ignored as we face the public health crisis of physician burnout.
 
Technology That's Improving the Doctor-Patient Relationship
The relationship between doctors and patients is dynamic and relies on direct communication. However, it's also filtered through the overall patient experience. Breakthroughs in technology have been made that not only improve care, but also open up new channels of communication for physicians.

Advances in digital devices allow 4D ultrasound allow doctors to not only share digital images almost immediately with expectant parents with one click, but also enable instantaneous collaboration with other clinicians in addressing any issues. The cloud-based system Tricefy™ allows immediate commentary from physicians and facilitates dialog from practically anywhere.

Enhancing clinical relationships requires not only better communication skills, but also tools that close the gap between diagnosis and patient understanding through a more educational and interactive experience. Patients can not only see what their doctors see, but also get more precise information, like the exact location of an issue. This is where portable technology, such as handheld ultrasound, gives teeth to initiatives attempting to improve the doctor-patient relationship.

Understanding the Power of Handheld Ultrasound
Handheld ultrasound has led the way to a new level of accessibility for providers, with some units being the size of a smartphone, while still providing quality images. According to the conclusion of a study published in The Acta Anaesthesiologica Scandinavica that compared the Vscan and the Vivid-i systems, "the Vscan displays image quality interchangeable with larger and more expensive systems. The apparatus is well-suited for performing a (focus-assessed transthoracic echocardiography) examination in a one-day surgery setting and could very well also be applicable in almost any situation involving patients with acute illness."

The simple nature of their portability can help doctors at the bedside, as well. Authors of a study published in The Annals of Internal Medicine concluded "that the use of ultrasound by hospitalists will continue to modernize the bedside evaluation and streamline the diagnostic process."

Consider the fact that the use of pocket mobile ultrasound devices (PUDs) has been found to actually spare patients the negative and often costly experience of unnecessary exams. According to a study published in PLOS One, "after a simple and short training course, a PUD examination can be used in addition to a physical examination to improve the answer to 10 common clinical questions concerning in- and outpatients, and can reduce the need for further testing."

Clinical settings, though, are just the beginning. Organizations such as Doctors To You are meeting patients where they are and leveraging technology like Vscan Extend™ to expand the reach of house calls. We're also entering a period where more employers are offering healthcare services in the workplace. Companies including Disney, Apple, Boeing, Cisco and Goldman Sachs now provide on-site clinics for their employees, further increasing the potential for portability and accessibility in diagnostic modalities like handheld ultrasound, and opening up an entirely new venue for the doctor-patient relationship.

Initiatives around improving outcomes and the patient experience can easily remain abstract without serious discussions about the technology that pulls them into clinical realities. Forward-thinking healthcare leaders should keep an eye out for developments like handheld ultrasound as foundational tools in improving doctor-patient communications.
>Read more