Evan A. Balmuth , Danny Luan, Deanna Jannat-Khah, Arthur Evans, Tanping Wong, David A. Scales
Abstract
Point-of-care ultrasound (POCUS) is an imaging modality used to make expedient patient care decisions at bedside. Though its diagnostic utility has been extensively described, POCUS is not yet considered standard of care in inpatient settings. Data from emergency department settings suggest that POCUS may yield socioemotional benefits beyond its diagnostic utility; furthermore, elements of the POCUS experience are known to promote placebo effects. These elements likely contribute to a placebo-like “POCUS positive care effect” (PPCE) with socioemotional benefits for receptive patients. Our objective is to provide the first characterization of the PPCE and its facilitating factors in an inpatient setting. In this novel mixed-methods study, we recruited 30 adult patients admitted to internal medicine floors in an urban academic medical center, recorded observations during their routine POCUS encounters, and administered post-encounter surveys. We conducted complementary quantitative and qualitative analyses to define and assess the magnitude of the PPCE. We also aimed to identify factors associated with and facilitating receptiveness to the PPCE. The results indicated that POCUS improves patients’ satisfaction with their hospital providers and care overall, as well as perceived care efficiency.
Introduction
Point-of-care ultrasound (POCUS) is an imaging modality performed at bedside to make expedient care decisions [1, 2]. First used in the emergency department (ED), POCUS has been increasingly leveraged by inpatient internal medicine providers. Beyond its established diagnostic advantages, studies of POCUS in the ED point toward additional benefits including improved patient satisfaction with care [3], confidence in the POCUS provider [4], and healthcare-associated cost savings [5, 6]. However, the socioemotional benefits of POCUS are only beginning to be explored and have not yet been characterized in the inpatient setting. Furthermore, the contextual factors which facilitate these benefits remain undefined.
Materials and method
This was a mixed-methods cross-sectional study based on qualitative analysis of POCUS encounter field notes and quantitative analysis of post-encounter surveys. Thirty adult patients admitted to internal medicine floors at NewYork-Presbyterian Hospital/Weill Cornell (NYP/WC) were identified by convenience sampling for POCUS observations, audio recordings, and surveys. Patients were eligible if they were age 18 years or older, admitted with a chief complaint of chest pain or shortness of breath, and would receive POCUS as part of their routine care. Patients were ineligible if they were pregnant, breastfeeding, unable or unwilling to independently provide consent. Potential participants were identified through chart review by one of two trained observers (DL and EB), medical students trained in POCUS for hospital internal medicine who were not involved in the patients’ clinical care.
Results
Thirty patients consented to participate in the study, among whom 27 completed post-encounter surveys. Baseline demographic and clinical characteristics of the 27 patients who completed post-encounter surveys are shown in Table 1. Patients’ median age was 63.0 years (IQR 59.0–75.0); 59% were men and 41% women. The majority of patients (85%) were English-speaking. The median patient-reported post-encounter chief complaint severity was 2.0 out of 5 (IQR 1.0–4.0). Patients’ median CCI was 5.0 out of 37 (IQR 2.0–6.0).
Discussion
The magnitude of PPCE was rated highly by all but one participant, as POCUS improved patients’ satisfaction with their providers and overall care, in addition to perceived care efficiency. Our finding that patients were generally very satisfied with POCUS mirrors that of prior publications, across ED and outpatient settings [3, 4, 43–45]. To our knowledge, this is the first study to assess patient satisfaction with POCUS in an inpatient internal medicine setting.
Conclusions
In this study, we applied a novel mixed-methods approach to provide the first characterization of the PPCE and its facilitating factors in the inpatient hospital setting. Based on our findings, we hypothesize that POCUS can be optimized to elicit a maximal PPCE for receptive patients, in a form we recommend calling “therapeutic POCUS.” Specifically, in the right context, the PPCE comprises socioemotional benefits including increased satisfaction with providers and overall care, as well as perceived care efficiency. Encounters that maximize mutual engagement, therapeutic alliance, and reassurance through image interpretation are likely most conducive to therapeutic POCUS; patients who have lower anxiety levels, less severe illness, and have experienced efficient care delivery during their hospitalization may be most receptive to therapeutic POCUS.
Citation: Balmuth EA, Luan D, Jannat-Khah D, Evans A, Wong T, Scales DA (2024) Point-of-care ultrasound (POCUS): Assessing patient satisfaction and socioemotional benefits in the hospital setting. PLoS ONE 19(2): e0298665. https://doi.org/10.1371/journal.pone.0298665
Editor: Aloysius Gonzaga Mubuuke, Makere University College of Health Sciences, UGANDA
Received: December 7, 2023; Accepted: January 29, 2024; Published: February 16, 2024
Copyright: © 2024 Balmuth et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant de-identified data are within the paper and its Supporting Information files.
Funding: This research was funded by the Weill Cornell General Internal Medicine Primary Care Innovation Seed Grant (https://careinnovation.weill.cornell.edu/rfps/seed-grants-innovative-primary-care-proposals-2021-2022), awarded to DAS and TW. The funders did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0298665#sec025
