Feasibility of point-of-care ultrasound during the emergency department triage: a prospective cohort study

TL;DR

This study explores whether ultrasound can be used during emergency room triage to improve patient prioritization.

Contribution

The study demonstrates the feasibility of nurse-performed point-of-care ultrasound during ED triage.

Findings

POCUS added 90 seconds to triage time but was feasible in practice.

POCUS reclassified 8% of urgent and 5% of less urgent cases more accurately.

Most patients were non-urgent, suggesting POCUS could help prioritize care.

Abstract

The primary aim of this study was to evaluate the feasibility of adding point-of-care ultrasound (POCUS) during the Emergency Department (ED) triage process. This prospective study enrolled two cohorts of adult patients presenting to the ED for a selected group of acute symptoms, previously selected on the basis of the presumed utility of POCUS during triage evaluation. The ED triage process was performed as recommended by the hospital guidelines or by including a nurse-performed POCUS evaluation. Only urgent or less codes were considered eligible for the study. The timing of all evaluations was recorded along with the opinion of the nurses involved in the study on the impact of POCUS results on the triage process. After ED discharge, the most appropriate triage code was determined by independent review of the triage data.

A total of 312 patients were enrolled, 101 of whom were evaluated with the hospital standard triage process. Nine nurses with expertise in both ED triage and POCUS were involved in the study. The majority of the enrolled patients were deferrable or minor urgency (about 60% in both groups). The median time needed for the triage evaluation was 180 seconds (range 540), 90 seconds longer in the POCUS group than in the standard triage group (p < 0.01). Net reclassification index of POCUS-implemented compared with standard triage protocol was 8% and 5% for urgent and less urgent cases.

This small single site study suggests that POCUS is feasible during the ED triage and it is potentially useful by triage nurses. However, future studies are needed to confirm POCUS potential usefulness for a more accurate triage process.

Figures