The Impact of Prehospital Point of Care Ultrasounds on Emergency Patients Length of Stay in Thailand

Abstract

Purpose

Globally, emergency departments (ED) are faced with an overcrowding problem. This issue is further compounded due to the multitude of contributing factors. Point of Care ultrasound (POCUS), especially when performed in prehospital care, that is before the patient is admitted to the ED has a high potential to reduce time of diagnosis and time of investigation which leads to shorter ED length of stay (LOS). The primary focus was on variances in ED LOS between the prehospital POCUS group and the standard care group.

Patients and Methods

A cross-sectional study was conducted on prehospital patients who were admitted to the ED at Srinagarind Hospital, Thailand, from January to December 2021. We divided patients into two groups including patients who obtained prehospital POCUS (the prehospital POCUS group) and patients who received standard care treatment in which there was no prehospital POCUS performed (the standard care group). POCUS and ED medical records were documented and submitted for analysis.

Results

Of 1348 prehospital patients, 840 were enrolled in this study: 169 with prehospital POCUS and 671 with standard care. Median LOS in the prehospital POCUS group was 159 min (IQR 89,289) versus 165 (IQR 102,330) in the standard care group (p = 0.125). Further imaging diagnostic test which affected ED LOS more than four hours was lower in the prehospital POCUS group (adjusted odds ratio [OR], 0.92; 95% confidence intervals [CI], 0.729–1.666) than in the standard care group. The factor associated with increased odds of ED LOS more than four hour in the prehospital POCUS group was admission to hospital (adjusted OR 1.88; 95% CI, 1.230-2.239).

Conclusion

Patients evaluated with prehospital POCUS had a shorter LOS than the only standard care treatment without statistical significance.

Keywords:

• ultrasonography
• prehospital emergency care
• length of stay
• emergency departments
• crowding

Abbreviations

ED, emergency department; POCUS, Point of Care Ultrasound; LOS, length of stay; OR, odds ratio; ED LOS, Emergency department length of stay; EMS, emergency medical services; EMR, electronic medical record; CIs, confidence intervals; EMTs, emergency medical technicians.

Data Sharing Statement

On reasonable request, the corresponding author will provide the data sets used and/or analyzed during the current work.

Ethics Approval and Informed Consent

This study was authorized by the the Khon Kaen University Ethics Committee for Human Research based on the Declaration of Helsinki and the ICH Good Clinical Practice Guidelines (HE651469). Because patient privacy was maintained by employing a unique research number, informed consent was waived.

Acknowledgment

The authors would like to express our sincere gratitude to Josh Macknick for acting as an English consultant.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This research was supported by the Fundamental Fund of Khon Kaen University which has received funding support from the National Science, Research and Innovation Fund (NSRF).