Is Point-Of-Care Ultrasound an Extension of the Physical Exam or a Formal Study? Yes

Course Overview

This workshop will guide participants through one of the core debates around integrating point-of-care ultrasound (POCUS) into internal medicine in ambulatory and acute care settings.

The conflict is the classification of POCUS as an augmentation of the physical exam as compared to a formal diagnostic imaging study. Both approaches have rational justifications depending on the clinical question, setting, and available resources.

Traditionally, a provider's history and physical exam has dictated their pre-test probability for a given diagnosis and guided either:

Empiric treatment
Additional diagnostics to confirm
Reject the diagnosis as too unlikely to pursue.

Integrating POCUS into the bedside evaluation can significantly refine this pre-test probability, improving the provider's diagnostic accuracy, expediting care, and reducing unnecessary studies. However, instances of misinterpretation with POCUS can lead to harm, and recorded images offer opportunities to improve training, communicate objective data between providers, and obtain reimbursement for a higher level of care. Unfortunately, the challenges of implementing an image archival system with formal documentation and quality assurance create significant barriers to entry and may be unnecessary.

In this workshop, POCUS leaders from two institutions across ambulatory care, acute care, and critical care settings will describe the different approaches taken, challenges faced, important areas of controversy, and, using models of Bayesian reasoning, we will propose a functional framework for determining which exams are better considered extension of the physical exam and which should be treated as formal studies.

Learning Objectives

The learner will be able to describe the value and implications of using POCUS as an augmentation of the physical exam to influence pre-test probabilities compared to using POCUS as a formal diagnostic imaging study.
The learner will be able to describe the differences in implementation of POCUS curricula in multiple clinical setting, including methods of education, oversight, and quality assurance.
The learner will leave with a collection of available resources (billing documents, legal documents, and educational content) and allies necessary to incorporating POCUS into internal medicine ambulatory and acute care settings.

Speakers

Brandon Fainstad, MD
University of Colorado School of Medicine

Cameron Baston, MD
Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania

Nilan Schnure, MD
Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania

Amiran Baduashvili, MD
Weill Cornell Medicine

Additional Information

Year Published: 2022 - AIMW