Title: Point of Care Ultrasound to Expedite Emergency Department Disposition

Authors:  Marilyn Bravo1*, Melissa Lopez1*, Deseray Sileo1*, Bryan D. Merte2, Ghadi Ganem1, Jaqueline Shibata2, Alan Chiem2

* These authors contributed equally to this work.
1 David Geffen School of Medicine

2 Olive View-UCLA - Dept Emergency Medicine

Area of Concentration (Petal): Medical Education

Specialty: Emergency Medicine

Keywords: POCUS, ED length of stay, Emergency Department

Background: Available literature demonstrates that ultrasound performed by Emergency Medicine physicians reduces reliance on radiology-performed studies, which expedites patient care.

Objective: Our retrospective study aims to evaluate the potential of Emergency Department (ED) point-of-care ultrasound (POCUS) to reduce ED length of stay (LOS) in patients presenting for abdominal or flank pain of suspected biliary or renal etiology, as compared to those who received other radiology studies (ORS). We also seek to identify other factors that may influence the potential of POCUS to reduce LOS.

Methods: We conducted a retrospective chart review of Olive View-UCLA ED visits in January 2023, selecting patients with discharge diagnoses associated with biliary or renal colic and those who received abdominal or retroperitoneal ED POCUS. See flowchart for exclusion criteria. A student’s t-test was used to compare ED POCUS and ORS groups using ED time to disposition as the primary outcome. 

Results: A total of 257 patients were analyzed (55.6% female, 44.4% male). Reported comorbidities included: hypertension (21.0%), hyperlipidemia (17.5%), diabetes (18.3%), obesity (30.7%), CKD (4.3%), gallstones (3.9%) and 44.4% had no relevant past medical history. 7.4% of patients met SIRS criteria while being evaluated in the ED.

Of the included patients, 147 received ED POCUS and 110 received ORS. The ED POCUS group had a mean LOS of 334 mins (95% CI [303.5, 364.3]) while patients who underwent ORS had a mean LOS of 390.6 minutes (95% CI [352.2, 429]) (P = 0.023).

Conclusions:  In the evaluation of ED patients with biliary or renal colic, ED POCUS was associated with a 56.6-minute shorter LOS, which was statistically significant when compared to study patients who received ORS, exemplifying the potential of ED POCUS to expedite ED disposition.