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Aust J Rural Health. 2018 Oct;26(5):342-349. doi: 10.1111/ajr.12472.

Point-of-care ultrasound in rural New Zealand: Safety, quality and impact on patient management.

Author information

1
Deans Department, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
2
Hokianga Health Enterprise Trust, Kaikohe, New Zealand.
3
Department of Population Health, University of Waikato, Hamilton, New Zealand.
4
School of Population Health, University of Auckland, Auckland, New Zealand.

Abstract

OBJECTIVE:

To evaluate the safety, quality and impact of point-of-care ultrasound on patient management when performed by rural generalist doctors.

DESIGN:

Cross-sectional descriptive study.

SETTING:

Six rural small hospitals serving a range of communities in rural New Zealand.

PARTICIPANTS:

All generalist doctors practising ultrasound in the study hospitals.

MAIN OUTCOME MEASURES:

Technical quality, accuracy, impact on diagnostic certainty, patient disposition and overall patient care.

RESULT:

Participants correctly interpreted 90% of images and a similar percentage of point-of-care ultrasound findings when compared with the results of formal imaging or the final diagnosis. In total, 87% of scans contributed to the diagnostic process, changing the diagnostic probability. There was a 4% overall reduction in the number of patients needing hospital admission or transfer to an urban base hospital. The overall impact on patient care was positive for 71% of point-of-care ultrasound scans. Three percent of scans had the potential for patient harm.

CONCLUSION:

Rural generalists' practise a broad scope of point-of-care ultrasound that, when used as a part of the full clinical assessment, has a positive impact on patient care, improving diagnostic certainty and reducing the need for hospital admission and inter-hospital transfer. There are challenges in learning and maintaining the skills needed to practise a high standard of point-of-care ultrasound in this context. Further consideration needs to be given to the development safe scopes of practice, training, credentialing and quality assurance.

KEYWORDS:

access to services; diagnostic imaging; rural health services; rural hospital; rural medical education

PMID:
30303278
DOI:
10.1111/ajr.12472
[Indexed for MEDLINE]

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