The Impact of Prehospital Point of Care Ultrasounds on Emergency Patients Length of Stay in Thailand

Kamonwon Ienghong; Lap Woon Cheung; Somsak Tiamkao; Vajarabhongsa Bhudhisawasdi; Korakot Apiratwarakul

doi:10.2147/JMDH.S396986

The Impact of Prehospital Point of Care Ultrasounds on Emergency Patients Length of Stay in Thailand

J Multidiscip Healthc. 2023 Jan 24:16:219-226. doi: 10.2147/JMDH.S396986. eCollection 2023.

Authors

Kamonwon Ienghong¹, Lap Woon Cheung^{2

3}, Somsak Tiamkao⁴, Vajarabhongsa Bhudhisawasdi¹, Korakot Apiratwarakul¹

Affiliations

¹ Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
² Accident & Emergency Department, Princess Margaret Hospital, Kowloon, Hong Kong.
³ Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
⁴ Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Abstract

Purpose: Globally, emergency departments (ED) are faced with an overcrowding problem. This issue is further compounded due to the multitude of contributing factors. Point of Care ultrasound (POCUS), especially when performed in prehospital care, that is before the patient is admitted to the ED has a high potential to reduce time of diagnosis and time of investigation which leads to shorter ED length of stay (LOS). The primary focus was on variances in ED LOS between the prehospital POCUS group and the standard care group.

Patients and methods: A cross-sectional study was conducted on prehospital patients who were admitted to the ED at Srinagarind Hospital, Thailand, from January to December 2021. We divided patients into two groups including patients who obtained prehospital POCUS (the prehospital POCUS group) and patients who received standard care treatment in which there was no prehospital POCUS performed (the standard care group). POCUS and ED medical records were documented and submitted for analysis.

Results: Of 1348 prehospital patients, 840 were enrolled in this study: 169 with prehospital POCUS and 671 with standard care. Median LOS in the prehospital POCUS group was 159 min (IQR 89,289) versus 165 (IQR 102,330) in the standard care group (p = 0.125). Further imaging diagnostic test which affected ED LOS more than four hours was lower in the prehospital POCUS group (adjusted odds ratio [OR], 0.92; 95% confidence intervals [CI], 0.729-1.666) than in the standard care group. The factor associated with increased odds of ED LOS more than four hour in the prehospital POCUS group was admission to hospital (adjusted OR 1.88; 95% CI, 1.230-2.239).

Conclusion: Patients evaluated with prehospital POCUS had a shorter LOS than the only standard care treatment without statistical significance.

Keywords: crowding; emergency departments; length of stay; prehospital emergency care; ultrasonography.

Grants and funding

This research was supported by the Fundamental Fund of Khon Kaen University which has received funding support from the National Science, Research and Innovation Fund (NSRF).