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Emergency Medicine International
Volume 2013, Article ID 946059, 8 pages
http://dx.doi.org/10.1155/2013/946059
Research Article

Does the Integration of Personalized Ultrasound Change Patient Management in Critical Care Medicine? Observational Trials

1Emergency Department, Hospital of the City of Frankfurt (Höchst), Gotenstraße 6-8, 65929 Frankfurt am Main, Germany
2Emergency Ultrasound Regional Network and the Frankfurt Institute of Emergency Medicine and Simulation Training, Johann Wolfgang Goethe University Hospital, Marienburgstraße 5-7, 60528 Frankfurt am Main, Germany
3Department of Cardiology, Kerckhoff Klinik Bad Nauheim, Benekestraße 2-8, 61231 Bad Nauheim, Germany
4Deptartment of Anaesthesiology and Intensive Care, Hospital zum Heiligen Geist, Lange Straße, 60311 Frankfurt, Germany
5Landeskrankenhaus Graz West, Abteilung für Innere Medizin, Göttinger Straße 22, 8020 Graz, Austria
6Städtisches Klinikum Neunkirchen, Brunnenstraße 20, 66538 Neunkirchen/Saar, Germany
7Brainfactory, 66288 Bildstock, Germany
8Trauma Surgery, Johann Wolfgang Goethe University Hospital, Theodor Stern Kai 7, 60590 Frankfurt am Main, Germany
9Department of Cardiology, Johann Wolfgang Goethe University Hospital, Theodor Stern Kai 7, 60590 Frankfurt am Main, Germany

Received 1 August 2013; Accepted 26 August 2013

Academic Editor: Tobias Lindner

Copyright © 2013 Raoul Breitkreutz et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective. To test the influence of personalized ultrasound (PersUS) on patient management in critical care. Design of the Study. Prospective, observational, and critical care setting. Four substudies compared PersUS and mobile ultrasound, work distribution, and diagnostic and procedural quality. Patients and Interventions. 640 patient ultrasound exams including 548 focused diagnostic exams and 92 interventional procedures. Main Outcome Measures. Number of studies, physician’s judgement of feasibility, time of usage per patient, and referrals to echo lab. Results. Randomized availability of PersUS increased its application in ICU work shifts more than twofold from 33 to 68 exams mainly for detection and therapy of effusions. Diagnostic and procedural quality was rated as excellent/very good in PersUS-guided puncture in 95% of cases. Integrating PersUS within an initial physical examination of 48 randomized cases in an emergency department, PersUS extended the examination time by 100 seconds. Interestingly, PersUS integration into 53 randomized regular ward rounds of 1007 patients significantly reduced average contact time per patient by 103 seconds from 8.9 to 7.2 minutes. Moreover, it lowered the patient referral rate to an echo lab from 20% to 2% within the study population. Conclusions. We propose the development of novel ultrasound-based clinical pathways by integration of PersUS.