Point-of-Care Ultrasound: A Life-Saving Game Changer

By Matt Phillion

Modern ultrasound technology can be a game changer, particularly for remote organizations with limited resources and staff. Point-of-care ultrasound specifically offers portability, ease of use, and immediate access. Sometimes, those benefits can even be a case of life or death.

This was true for at least one patient under the care of Mark Favot, MD, associate professor and section chief of emergency medicine ultrasound at Wayne State University School of Medicine in Detroit. Favot also works shifts at a not-for-profit acute care facility about two-and-a-half hours from the city.

“I’ve been in ultrasound or point-of-care ultrasound for 10 or 11 years now, working primarily in Detroit—where there’s almost as many hospital ED visits as there are people,” says Favot. “But for about three years I’ve been working on the western side of the state, in an extremely rural area.”

Favot had made use of the ultrasound machine on-site at the rural facility, which was “a half-decent machine, a couple of generations vintage,” says Favot. It worked, but it clearly hadn’t been seeing regular use—often tucked behind carts, an EKG machine, or whatever debris had to be stored in front of it.

About a year ago, Favot began bringing in a hand-held ultrasound machine, Kosmos™, developed by the ultrasound technology company EchoNous. This generated some buzz with the staff. “Newer tech doesn’t happen all the time in rural settings,” says Favot, as organizations with fewer resources tend to lean on technology already in hand.

Simultaneously, while the facility was finally beginning to get its COVID-19 cases under control, there just weren’t enough staff available. “The narrative of the pandemic was starting to shift at the same time I brought the machine to the hospital. We’d have days when we wouldn’t have labs available for 12 hours because lab techs weren’t available and there was a gap in service coverage,” says Favot.

Most hospitals have labs, Favot notes, but the staffing problem demanded a quick solution. “Imaging was another place you saw an exodus of staff, and suddenly imaging tests weren’t routinely available, and at a small enough organization they aren’t going to pay triple the rate to have someone come in and do two CT scans in 12 hours,” he says.

With this backdrop, ultrasound became an even more powerful tool. It couldn’t take the place of labs, but it could give physicians information about a patient’s level of sickness, help to home in on the diagnosis, and get closer to the truth than a simple history and physical would allow.

“Imaging is a precise, high-value tool, and having it at the bedside made an even bigger difference,” he says.

During his shifts at the rural facility, Favot says the hand-held imaging device got a lot of attention, and that attention crystallized on a Saturday night in January.

Life-saving intervention

That night, a seemingly healthy 34-year-old woman came into the emergency department around 7 p.m. “It was the end of my shift, and when someone comes in at the end you eyeball them” to judge whether they can be seen by the incoming physician or whether their condition needs immediate intervention, says Favot.

This particular patient immediately raised his concerns. “I took a look and said, ‘This is someone I have to pay attention to right now.’ Her vital signs were all abnormal,” says Favot.

He got his hand-held ultrasound out and began speaking with the patient, who said she’d had COVID-19 back in November but didn’t think a lot of it. She’d been vaccinated and thought she’d recovered, but after a month she realized she hadn’t been feeling right. Her legs were swollen, she’d been having trouble going up and down stairs, and lying down flat was causing her to become increasingly short of breath.

The patient went to an urgent care facility about 10 miles from the hospital, where tests were ordered and x-rays were taken. After a radiologist interpreted the images, the urgent care facility informed the patient that her heart was enlarged and urged her to get an echocardiogram. “They called in a prescription for a ‘water pill,’ and 24 hours later she thought, ‘I’m not going to make it to the echocardiogram.’ The place they’d referred her to for the test didn’t have the staff anymore,” Favot says.

Using the hand-held device, he performed an ultrasound and found the patient’s heart was failing: There was fluid throughout her lungs, and one of her ventricles was nearly twice its normal size. Favot and the hospital staff were able to figure out that she’d contracted post-COVID-19 myocarditis (inflammation of the heart leading to acute heart failure). They made a few phone calls, and within 90 minutes, she was transferred to a hospital with a cardiovascular physician.

All of this, Favot notes, would have been a hard sell without the immediate results of a point-of-care ultrasound.

Improving point-of-care access

With results like this case, Favot says, it’s worth thinking about a couple components of the future of ultrasound.

The first component is that American medical schools are actively looking to train students in point-of-care ultrasound. Some schools have well-developed programs, he says, but ultrasound “is not like riding a bike. You don’t just get this skill and have it,” says Favot. “If I go on vacation for two weeks and pick up the device [afterward], I need to get reoriented, and that takes a lot of ongoing practice.” Having an ultrasound system that is yours, so you’re not constantly switching from device to device, helps circumvent this challenge, he says.

Point-of-care ultrasound devices are going down in cost and producing better-quality images. “A lot of users have very shaky confidence in old handhelds, but new devices like the Kosmos have a high-quality image capability that gives someone like me confidence, and also gives a new generation of physicians who already have training with baseline skills in ultrasound the ability to quickly use it,” says Favot.

The second component is that much of medical education has moved to remote learning. “This is fine for a lot of medical education, but when you’re talking about a complex psychomotor skill, Zoom® doesn’t cut it,” says Favot.

But if instructors can reach people at their physical location through Zoom, for example, and the ultrasound itself has features baked in to supplement that instruction, students can have detailed discussions and get meaningful feedback. For its part, Kosmos can be paired with EchoNous’ ultrasound education portal, Kosmos UP, enabling students to upload images and have them reviewed by instructors remotely.

Inertia and disruption

So why aren’t more point-of-care ultrasound devices making their way to physicians?

“Sometimes it’s inertia—for medicine and biomedical research, the translation time between new findings and new tech and when it becomes routinely incorporated is very long,” says Favot.

Many emergency physicians practicing now finished their training and developed practice patterns before hand-held devices were available. “As an educator, that’s a difficult problem to tackle,” says Favot. “You need equipment and systems in place that remove barriers with a simple user interface and navigation. You don’t want to have to input 500 pieces of information to get started.”

Also, ultrasound is a visual medium, Favot says. The patient and family are often watching, and that can be intimidating for the physician.

For earlier training, there’s competition for students’ time, and ultrasound training can be labor intensive. “You’ve got to carve out time in the curriculum while everyone is fighting for their lecture,” says Favot. “A lot of times that means it’s at 5 p.m. on a Thursday or Friday. If the school is fully committed to it, it’s treated like everything else, but that takes time and personnel resources.”

Beyond training, bringing disruptive technology into a healthcare setting can have its own challenges, whether legal, regulatory, or of course financial. “A hospital executive team, seeing this disruptive solution to the problem, [may] ask, ‘What’s wrong with the way we do it? You’re telling us our existing processes aren’t good enough?’ ” says Favot. “The answer is that this will improve what we’re doing. It isn’t in lieu of.”

Favot suspects hand-held point-of-care ultrasound devices will be adopted from the bottom up. “When a critical mass of rank-and-file physicians demand it, they’ll figure out a way to get it on their own dollar and time,” says Favot. “It may take some time as those who think the status quo is good enough” step away.

Disruptive technologies offer an opportunity to improve patient care, as well as the experience of physicians and other staff.

“A lot of medical schools have student-run ultrasound groups, and they’re demanding this training and seek it out in their residency,” says Favot. “If you’re not making this part of what you’re doing, you risk being left behind. I’ve seen significant movement in healthcare. The horse has left the barn.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.