Clinical impact of adding community nurse-led point-of-care ultrasound
Research type
Research Study
Full title
Should point-of-care ultrasound be added to the community-based diagnostic pathway for older people with breathlessness? A pilot study of acceptability, clinical impact, and resource use.
IRAS ID
276876
Contact name
Emma Rees
Contact email
Sponsor organisation
Swansea University- Research Engagment & Innovation Services
Duration of Study in the UK
0 years, 5 months, 1 days
Research summary
We seek to assess whether adding nurse-led POCUS to the community-based pathway for older people with breathlessness would improve the ability to test for left ventricular systolic dysfunction. This could positively impact on clinical outcomes while reducing inappropriate referrals.
Dyspnoea affects 25% of people aged >65 years. It is a complex, multifactorial condition that impairs daily function and reduces quality-of-life (QOL). However, making a diagnosis at the point of presentation can be difficult because clinical examination and first-line tests lack accuracy for differentiating between causes which can contribute to unscheduled care, inappropriate hospital referrals, and treatment delays.
New, hand-held ultrasound machines offer the tantalising prospect of providing a more accurate ‘triage’ test at the point-of-care. There is a growing pool of evidence that the addition of POCUS can improve diagnosis and can be utilised to diagnose reduced heart function. However, current literature has focused on hospital and outpatient settings and there is little evidence about the cost- effectiveness and clinical impact of changing service models.
In this single-arm, single-centre, prospective pilot study of comparative clinical accuracy, nurses will add POCUS to the existing clinical pathway for older people (>60y) with dyspnoea referred to a community Acute Clinical Team and document if/how this would influence their original management plan. All scans will be reviewed by an accredited specialist using a PC/cloud-based server. We will assess whether adding POCUS improves the diagnostic accuracy of the pathway and offers better value-based healthcare by reducing time to accurate diagnosis, allowing appropriate treatments sooner, reducing wasted resources, and reducing inappropriate referrals. Resource use and costs associated with adding point-of-care ultrasound will be documented. The impact of dyspnoea on daily living and QOL will be explored using validated patient reported outcome measurement tools.
REC name
East of England - Essex Research Ethics Committee
REC reference
21/EE/0253
Date of REC Opinion
21 Dec 2021
REC opinion
Further Information Favourable Opinion