Admit or Not to Admit? Decide with Ultrasound

Admit or Not to Admit? Decide With Ultrasound

Hospital admission costs are enormous. Whether universal insurance coverage is available or not, the monetary cost of hospital admission and its associated pressure on the economy are major talking points.

Globally, individuals, governments, and insurance companies budget billions of dollars to finance admissions and patient rehabilitation efforts, but the real question is: 

‘Are these budgets sustainable, or at least worth it?’

As simple as it sounds, this question deserves more than just a ‘yes’ or ‘no’ – even if it is not open-ended.  In fact, the right response should stem from a critical analysis of cost-benefit ratios, sustainability indexes, and other metrics that match spending to utility derivation in healthcare. This article examines the worth of these spendings, and how point-of-care ultrasound could help save cost.

Appropriate Vs Inappropriate Hospital Admission: What the Data Says

Data from key international organizations including the Organization for Economic Co-operation and Development (OECD) present a true picture of global healthcare spending. In 2018, a study utilizing this data compared the potential drivers of healthcare spending including structural capacity and utilization in the United States and 10 of the highest-income countries: Sweden, France, Netherlands, Australia, Japan, Denmark, the Netherlands, Canada, Germany, and the United Kingdom.

Study results showed that the US spent 17.8% of its gross domestic product on healthcare. The same metric from other countries ranged from 9.6% (Australia) to 12.4% (Switzerland). In monetary terms, these percentages translate to hundreds of billions of dollars (1). Beyond government spending, hospitals also incur huge costs to sustain an admission cycle.

For instance, a 2019 review showed how the total cost of admission for ventral cavity surgical procedures was highest in the Americas; an average of $15,791 (2). Another study pegged the median financial out-of-pocket hospital admission costs for children with a febrile illness in North East England at £56.25 (3).

Despite this huge spending, region-specific healthcare outcome metrics suggest poor implementation or inappropriate admission. A reference study published in the Journal of Internal Medicine estimated the percentage of cost implications of inappropriate admissions.

Using estimates of health benefits and necessary care levels in 422 admissions, the study showed how 12% of total hospital admissions were inappropriate (4). Another study, using the Appropriateness Evaluation Protocol (AEP), found that 7.4% of admission and 24.6% of stays were inappropriate (5). Aggregating these findings partially explains why the global cost of hospital admission – and by extension, healthcare spending – is enormous.

It appears there could be a concerning disconnect between clinicians’ decision-making process on admissions and the overall appropriateness of these admissions.

Cost-effective Hospital Admissions: Point-of-care Ultrasound to the Rescue

As an innovative imaging modality, POCUS commands huge utility beyond diagnostics in modern medicine. Its versatility, accuracy, and advanced technology features make it the clinicians’ magic wand – a best-in-class clinical tool complimenting the conventional methods of physical examination (for which ultrasound has been suggested as the new “5th pillar”), laboratory investigations, and medical X-rays.

By deploying this bedside solution, clinicians can make informed decisions on admission needs, saving costs and reducing the risk of delivering better clinical outcomes. Implementing Point-of-Care Ultrasound (POCUS) in primary health care can reduce government spending and deliver additional benefits. Here’s how:

 1.   Reduced Misdiagnosis Errors

POCUS leads the pack of innovative clinical imaging modalities developed in the last decade. Its superiority stems from its accuracy in identifying anatomical anomalies in different organ systems. Compared to conventional imaging techniques, POCUS is less invasive and radiation-free, making it a method of choice in children and special populations.

By leveraging its many imaging capabilities, clinicians can accurately visualize structural defects almost immediately at presentation. In pulmonology, POCUS outperforms both auscultation and chest X-rays in the intensive care unit, reducing diagnosis errors and the rate of inappropriate admissions (6).

In pediatric care, POCUS adoption decreases the misdiagnosis rate of intussusception – the most common abdominal emergency in early childhood (7). Today, POCUS has at least one major use case in every branch of medicine, serving as a standard diagnostic tool. Its continued adoption and implementation are projected to help clinicians make better verdicts.

 2.   Tracking Disease Severity and Clinical Complications

POCUS’s real-time capabilities, sensitivity, and ease of operation make it the right tool to track the severity of disease conditions. At different stages of clinical management, clinicians aim to follow disease evolution as a metric to ascertain the effectiveness of therapy.

In 2023, the Journal of Clinical Medicine published a study evaluating the utility of point-of-care ultrasound for early detection of valvular heart disease (VHD) and its severity. All patients recruited for the study completed a standard echocardiogram before therapy initiation. With subsequent examinations, the researchers compared the accuracy of POCUS and standard transthoracic echocardiography in detecting and tracking disease evolution (8).

Study results showed how POCUS identified patients with significant VHD, an outcome that significantly influenced clinical outcomes. Ultrasound also serves powerful screening functions in detecting clinical complications during therapy. For instance, lung POCUS was widely deployed during the COVID-19 pandemic as a standard diagnostic modality for detecting lung pathologies such as pneumonia and chronic heart failure in immunocompromised patients.

3.   Discharge Criteria

Oftentimes, hospital length of stay is prolonged by the difficult challenge of deciding whether or not to discharge patients quickly; this might not necessarily be a skill issue. POCUS changes this situation by equipping clinicians with accurate, real-time imaging data to decide faster. By offering multi-organ imaging at different levels of depth and resolution, POCUS gives the clinician a 360-degree view of how tissues and organ systems heal.

This real-time data improves the time to treatment, tracks patient response to therapy, and evaluates the physiological integrity of organ systems. These benefits positively impact clinicians’ decision to discharge a patient or not. Of course, the overall result is reduced hospital stay days and a lowered cost of care.

 Conclusion: Consider an Ultrasound Investment

A POCUS investment delivers huge returns. Judging from the increased trend in POCUS adoption in recent years, its integration with daily clinical routines is returning immense benefits. The recent development of advanced AI ultrasound also expands its use, serving more than just a diagnostic tool for clinicians.

In its expanded deployment, POCUS helps clinicians make better decisions about patient management — ranging from determining whether to admit a patient to helping patients save on huge costs. Schedule a Kosmos ultrasound demo to understand how this innovative technology can help your practice.

Frequently Asked Questions

1. Is POCUS only good for screening?

Beyond its accurate screening capabilities, POCUS serves many other clinical purposes, including helping clinicians understand disease evolution, tracking treatment, and deciding whether or not to discharge a patient. 

2.  Is POCUS safe for children and pregnant women?

Compared to conventional diagnosis techniques like X-ray and Computed Tomography, point-of-care ultrasound is less invasive and radiation-free. So, it is safer for children and pregnant women.

3.  Can POCUS be integrated into outpatient care?

Absolutely. POCUS is increasingly used in outpatient nephrology settings for volume assessment, dialysis access evaluation, and detecting structural abnormalities without referring patients for formal imaging.

References

1. Papanicolas, I., Woskie, L. R., & Jha, A. K. (2018). Health Care Spending in the United States and Other High-Income Countries. JAMA, 319(10), 1024–1039. https://doi.org/10.1001/jama.2018.1150
2. Chen, B. P., Clymer, J. W., Turner, A. P., & Ferko, N. (2019). Global hospital and operative costs associated with various ventral cavity procedures: a comprehensive literature review and analysis across regions. Journal of Medical Economics, 22(11), 1210–1220. https://doi.org/10.1080/13696998.2019.1661680
3. van der Velden, F. J. S., Lim, E., Smith, H., Walsh, R., & Emonts, M. (2024). Quantifying the costs of hospital admission for families of children with a febrile illness in the North East of England. BMJ pediatrics open, 8(1), e002489. https://doi.org/10.1136/bmjpo-2023-002489
4. Eriksen, B. O., Kristiansen, I. S., Nord, E., Pape, J. F., Almdahl, S. M., Hensrud, A., & Jaeger, S. (1999). The cost of inappropriate admissions: a study of health benefits and resource utilization in a department of internal medicine. Journal of Internal Medicine, 246(4), 379–387. https://doi.org/10.1046/j.1365-2796.1999.00526.x
5. Soria-Aledo, V., Carrillo-Alcaraz, A., Campillo-Soto, A., Flores-Pastor, B., Leal-Llopis, J., Fernández-Martín, M. P., Carrasco-Prats, M., & Aguayo-Albasini, J. L. (2009). Associated factors and cost of inappropriate hospital admissions and stays in a second-level hospital. American journal of medical quality: the official journal of the American College of Medical Quality, 24(4), 321–332. https://doi.org/10.1177/1062860609337252
6. Smallwood, N., & Dachsel, M. (2018). Point-of-care ultrasound (POCUS): unnecessary gadgetry or evidence-based medicine? Clinical medicine (London, England), 18(3), 219–224. https://doi.org/10.7861/clinmedicine.18-3-219
7. Hsiao, H. J., Wang, C. J., Lee, C. C., Hsin, Y. C., Yau, S. Y., Chen, S. Y., Lo, W. C., Wu, P. W., Chen, C. L., & Chang, Y. J. (2021). Point-of-Care Ultrasound May Reduce Misdiagnosis of Pediatric Intussusception. Frontiers in pediatrics, 9, 601492. https://doi.org/10.3389/fped.2021.601492
8. Wen, S., & Naqvi, T. Z. (2023). Point-of-Care Ultrasound in Detection, Severity and Mechanism of Significant Valvular Heart Disease and Clinical Management. Journal of Clinical Medicine, 12(20), 6474. https://doi.org/10.3390/jcm12206474