Expand bedside physical examination with POCUS

Time to add a fifth pillar to bedside clinical examination: inspection, palpation, percussion, auscultation and insonation.

Ultraportable clinical ultrasound probes have the advantage of being personal: they are immediately available, either in your pocket or in every room of the department.

When an imaging facility is not on site, point-of-care ultrasound is the only imaging modality that lends itself to true point-of-care service provision.

Portable, personal clinical ultrasound probes significantly improve patient care. They enable earlier, safer pre-diagnosis, and improve the relationship between professional and patient. On a hospital scale or, more generally, in terms of healthcare organization, they can also represent significant cost savings.

POCUS gives doctors immediate access to clinical problems for faster, more direct management.

The strengths of handheld devices result in several opportunities: ultrasound may be performed by a wider range of healthcare providers with varying levels and with different types of education. Handheld devices may also facilitate the use of ultrasound for teaching purposes.

The most recent studies highlight the fact that clinical ultrasound must be part of the specialty's core competencies.

Portable devices can considerably reduce the overall time required for performing an ultrasound examination at the bedside.

Physicians should examine the central veins with great precision by ultrasound to find the best vein for cannulation.

To compensate for a shortage of sonologists and sonographers in low-income countries, training midwives to undertake routine focused obstetric scanning for identification of high-risk pregnancies is a very viable option.

Point-of-Care ultrasound changes the management in specific groups of patients in the Emergency Department. It seems intuitive that POCUS holds an unexploited potential on a wide variety of patients.

Bedside ultrasound is associated with improved patient satisfaction, perhaps as a consequence of improved time to diagnosis and decreased length of stay.

Studies show that clinical ultrasound is associated with greater diagnostic accuracy.

For patients with acute abdominal pain, bedside ultrasound examination is related to higher satisfaction and decreased short-term health care consumption.

The SFMU points out that the use of POCUS in an emergency setting is justified by its efficiency in terms of clinical and diagnostic response, and the ease with which skills can be acquired and maintained.

Addition of ultra-sound imaging to the standard bedside physical examination has performed particularly better for correctly identifying the presence of less severe disease.

Given that the biggest gap is in provision of diagnostics at the level of primary health care, which is also the entry point to the care cascade, we also recommend that, as a priority, a set of key point-of-care diagnostics (point-of-care tests and point-of-care ultrasound) be made available at all primary health-care centres.