The use of hand-carried ultrasound in the hospital setting - A cost-effective analysis

Objectives: We sought to assess the accuracy of hand-carried ultrasound (HCU) in the prediction of a normal study, and its cost-effectiveness in reducing the number of standard departmental echocardiograms; (SDE) performed on hospital inpatients. Methods: The setting was a district general hospital. Participants were 157 consecutive inpatients, mean age 68 (range: 18-97) years, 95 men (61%), referred for SDE. HCU was performed at the bedside as part of the clinical assessment. SDE was performed routinely. Main outcome measures were: (1) assessment of the accuracy of HCU in detection of a normal or abnormal study as determined by SDE; and (2) a cost-effectiveness analysis. Results. Indications for echocardiography were: left ventricular (LV) function assessment, n = 101 (64.3%); valvular abnormalities, n = 11 (7%); arrhythmia, n = 4 (2.6%); miscellaneous, n = 10 (6.4%); and no reason stated, 31 (19.7%). The sensitivity, specificity, and positive and negative predictive values of HCU predicting a completely normal scan were 74%, 96%, 94%, and 81%, respectively, and of predicting normal LV function in requests specific for LV function assessment were 81%, 100%, 100%, and 77%, respectively. If either all inpatients or those with requests for LV function assessment underwent HCU initially, and only those with abnormal scans underwent further SDE, there would be a 29% and 22% reduction in departmental workload and a cost saving of 23,000 pounds and 30,000 pounds, respectively. Conclusion: HCU is an accurate method of identifying patients with normal hearts as determined by SDE. Its routine use is cost-effective and can significantly reduce the number of SDE that need be performed.