Authors: Michael F Barton, Charles H Brower, Brenna L Barton, Nicole M Duggan, Christopher W Baugh, George E Haleblian, Andrew J Goldsmith
Journal: American Journal of Emergency Medicine
Publication Date: September 21, 2023
Conclusion:
- Adopting a POCUS-first approach for assessing suspected nephrolithiasis in patients who adhere to Choosing Wisely guidelines could catalyze substantial national cost savings, reductions in ED LOS, and mitigation of preventable radiation exposure.
- Further research is warranted to investigate the obstacles to adopting this clinical workflow broadly and to explore the merits of a POCUS-first approach in various patient demographics.
Methods:
- A Monte Carlo simulation was created, integrating estimates for the frequency of ED visits due to nephrolithiasis and the eligibility for a POCUS-first approach.
- The study population encompassed all ED patients diagnosed with nephrolithiasis.
- The model was utilized in 1000 trials to estimate national cost savings through averted advanced imaging, as well as reductions in ED LOS and preventable radiation exposure.
Results:
- An estimated mean (±SD) of $16.5 million (±$2.1 million) could be saved annually by avoiding 159,000 (±18,000) Non-Contrast Computed Tomography (NCCT) scans through a POCUS-first approach.
- This strategy could also result in a cumulative annual decrease of 166,000 (±165,000) bed-hours in ED LOS.
- A cumulative reduction in radiation exposure of 1.9 million person-mSv is projected, which could potentially avert 232 (±81) excess cancer cases and 118 (±43) excess cancer deaths annually.
Barton, M.F., Brower, C.H., Barton, B.L., Duggan, N.M., Baugh, C.W., Haleblian, G.E. and Goldsmith, A.J., 2023. POCUS-first for nephrolithiasis: A Monte Carlo simulation illustrating cost savings, LOS reduction, and preventable radiation. The American Journal of Emergency Medicine.