In the last decade, point of care ultrasound (POCUS) has changed the landscape of global healthcare. In countries with robust hospital technologies, such as the U.S., POCUS helps decrease time to treatment, cost, and radiation exposure.
Globally, and particularly in resource-poor and nonhospital settings, point of care ultrasound uses fill a gap where other diagnostic imaging is not available. Due to its single-provider ease of use, portability, accessibility, and low cost, point of care ultrasound can improve outcomes and provide an essential tool to identify the needs of patients in real time.1
A snapshot of POCUS's many applications around the world highlights why this technology continues to grow within global healthcare.
Low-and-Middle Income Countries
In many low-and middle-income countries (LMICs), POCUS takes the place of high-tech imaging studies when there are barriers to other forms of evaluation. Workflows in developed hospital systems typically involve first obtaining the POCUS device before integrating training programs, utilizing the device, and then implementing referrals for care based on findings. However, barriers to access, training, and remote settings in LMICs can present breaks in the workflow at any of these given points.
The expansion of training has widened access for more doctors across the globe. Below are some examples of how point of care ultrasound uses and entry points into the global landscape can begin to address gaps and improve care.
Emergency Care in Tanzania
In Muhimbili National Hospital (MNH), Tanzania's largest referral hospital and home to the country's first full-capacity emergency department (ED), access to radiology studies can face limitations of cost, travel, and accessibility. In response, the hospital has recognized the utility of point of care ultrasound in the last decade.
Since the opening of the ED in 2010, the use of POCUS was found to have changed the clinical course of patient care in more than a quarter of patients seen at MNH following one ultrasound study, and in close to one half of patients in which more than one POCUS study was performed. The most likely uses of POCUS involved trauma, respiratory concerns, and abdomino-pelvic presentations.2 The focus has now zeroed in on training programs to reach as many healthcare providers as possible with foundational knowledge of how to use point of care ultrasound.
Train-the-Trainers Model in Peru
In 2015, the Ministry of Health of Peru required all EDs treating critically ill patients to have an ultrasound available, thus eliminating one barrier to access. However, many ultrasounds went unused due to lack of training. The first ultrasound fellowship in Peru was established to not only teach individual healthcare workers proper usage but also to establish a longitudinal approach to training future POCUS educators.
A train-the-trainers model can amplify use of POCUS in resource-poor settings.3 This model addresses immediate workflow gaps within Peru to move from having POCUS to actually utilizing POCUS. In turn, it also creates exponential growth for more people to train others to do the same.
Maternity Care in the Philippines
In the Philippines, the major causes of maternal and neonatal death are hemorrhages and obstructed labor. Because women in rural and low-income groups often lack access to ultrasounds during pregnancy, one study aimed to demonstrate the benefits of handheld ultrasound devices for obstetric care, measured in maternal and neonatal deaths averted.4 In line with the World Health Organization's Global Strategy on Human Resources for Health: Workforce 20305, community healthcare workers were given basic obstetric training using ultrasound for prenatal screening. The study estimated ultrasound averted 6.3% of possible maternal deaths and 14.6% of possible neonatal deaths through early detection and referrals to address complications.4
Infectious Diseases
Globally, point of care ultrasound also plays a role in the management of infectious diseases. When managing malaria, abdominal ultrasound has become a part of the screening score for evaluating the liver, spleen, and other organs. Echinococcus, a parasitic disease that causes cystic structures, can have a variety of effects ranging from asymptomatic disease to death.
Treatment often involves careful drainage of the parasitic cysts. In these cases, the WHO recommends ultrasound over other forms of imaging. Furthermore, with the higher prevalence of human immunodeficiency virus (HIV) in areas such as sub-Saharan Africa, POCUS can prove useful lieu of other imaging to evaluate opportunistic lung infections.1
Harsh Environments
POCUS has also been shown to carry significant benefits amid deployed military settings, global health crises, humanitarian assistance missions, and environments ranging from high-altitude settings all the way to the International Space Station.6,7
POCUS has recently proven invaluable in the care of COVID-19 patients. By allowing for bedside and real-time evaluation of patients in isolation, it lowers the risk of exposure. It has also been a valuable point-of-care tool to assess COVID pneumonia and the severity of respiratory failure.
Including POCUS Across Healthcare Interactions
Around the world, POCUS is finding its way into new and exciting arenas to aid in patient care. POCUS offers a practical ultrasound option in specialties that had previously not utilized the technology, replacing more expensive and less accessible diagnostic imaging.
Point of Care Ultrasound uses and applications are widely accepted as standard in trauma and emergency rooms. Now, other core areas of medicine utilize POCUS as a high-quality diagnostic and therapeutic tool as well, including:
Obstetrics
Anesthesia
Critical care
Pediatric and neonatal intensive care
Pulmonary
Cardiology
Gastrointestinal
Musculoskeletal
Out-of-hospital settings such as sporting events
Although these global examples are not entirely comprehensive, they serve as models for how others can build out their use of POCUS to improve access with real-time diagnostics. In addition, the healthcare community can learn cost-saving strategies for global healthcare practices without sacrificing quality imaging and information.
These use cases also show how the utilization of community healthcare workers and nonhospital first responders can enhance patient care and the healthcare workflow as a whole. Although existing models in well-developed medical systems often serve as pillars of care, pointing to how countries with less developed healthcare technology infrastructure utilize POCUS can help inform health practices across the board.
References:
1. Tran TT, Hlaing, M Krause, M. Point-of-Care Ultrasound: applications in low- and middle-income countries. Current Anesthesiology Reports. 2021; 11;69–75. https://doi.org/10.1007/s40140-020-00429-y
2. Reynolds TA, Amato S, Kulola I, et al. Impact of point-of-care ultrasound on clinical decision-making at an urban emergency department in Tanzania. PLoS One. 2018; 13(4):e0194774. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0194774
3. Dreyfuss, A., Martin, D. A., Farro, A., et al. A novel multimodal approach to point-of-care ultrasound education in low-resource settings. The Western Journal of Emergency Medicine. 2020; 21(4), 1017–1021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7390551/
4. Dalmacion GV, Reyles RT, Habana AE, et al. Handheld ultrasound to avert maternal and neonatal deaths in 2 regions of the Philippines: an iBuntis® intervention study. BMC Pregnancy Childbirth. 2018; 18(1):32. https://doi.org/10.1186/s12884-018-1658-8
5. World Health Organization. Global strategy on human resources for health: workforce 2030. WHO.int. https://apps.who.int/iris/bitstream/handle/10665/250368/9789241511131-eng.pdf?sequence=1&ua=1. Accessed May 22, 2022. Accessed May 22, 2022.
6. Sullivan JF, Polly M, Brasil MD, Roman JW, MC, et al. Utility of point of care ultrasound in humanitarian assistance missions. Military Medicine. 2021; 186:Supplement 1:789–794. https://doi.org/10.1093/milmed/usaa348
7. Laleh Gharahbaghian, Kenon L. Anderson, Viveta Lobo, et al. Point-of-care ultrasound in austere environments: a complete review of its utilization, pitfalls, and technique for common applications in austere settings. Emergency Medicine Clinics of North America. 2017; 5:2: 409-441. https://www.sciencedirect.com/science/article/abs/pii/S0733862716301213?via%3Dihub
