These days, care is all about delivering the highest quality for the lowest cost. Sometimes, this involves standard re-evaluation of management and clinical practices. Other times, hospitals turn to more innovative solutions. Minneapolis-based Abbott Northwestern Hospital is one of these innovators. Under the direction of David Tierney, MD, Abbott Northwestern is improving quality of care through expanding use of the portable ultrasound.
Ultrasound is traditionally used in emergency medicine and in intensive care units to get quick answers for very sick patients. However, Dr. Tierney, assistant program director of internal medicine residency and director of the internal medicine bedside ultrasound program (IMBUS), saw how incorporating ultrasound use into general patient care could be a useful tool for the internal medicine physician as well.
He started the IMBUS program in 2011 to provide more accurate and efficient care to internal medicine patients. Previously, the internal medicine physicians had relied primarily on tools such as the stethoscope to examine patients. The advent of cost-effective portable ultrasound technology around that time allowed Abbott Northwestern to begin the pilot program in portable ultrasound use to better examine and diagnose patients.
"Seventy-five percent of what we do with a traditional physical exam we can do much, much better with ultrasound at the bedside," says Dr. Tierney. "In the internal medicine residency program we have a responsibility to train physicians to be really good physical diagnosticians. As our patient population gets more complex and difficult to examine, the diagnostic ability of traditional tools such as our hands and stethoscopes isn't good enough, especially when looked at from an evidence-based medicine standpoint."
Portable ultrasound is less expensive, more convenient and does not involve radiation like CT scans and X-rays. From a cost and radiation standpoint, a physician can not order a CT scan every time he or she needs further information on a patient's internal state, the portable ultrasound is safe to use repeatedly. "We can get better exam results right at the bedside, which allows us to get to correct answers and treatment more quickly," says Dr. Tierney. "When we can treat patients faster and more accurately, they get better quicker, and it helps the hospital."
The IMBUS program also presents an excellent learning opportunity in diagnostics for internal medicine residents, who have the advantage of detailed physician feedback for each ultrasound exam they complete. This is possible through IMBUS's wireless communication component. Using iPhones, residents record the results and interpretations of every exam they perform through a custom app built by the hospital and created using FileMaker, a database software company, as a platform. These exam records are sent wirelessly back to a central database, where a physician double-checks them. The combination of portable app and centralized exam record database review ensure quality of treatment as well as certainty of expertise where any clinician learning to use the portable ultrasound program is concerned.
What began as a specialty-specific program is now being introduced hospital-wide, as the IMBUS program completes its second year of a 13,000 patient, four-year, patient care improvement study at Abbott Northwestern. The study is tracking major systemic outcomes, such as the cost of hospitalization, resource utilization, appropriate antibiotic use, time in the intensive care unit, and patient satisfaction scores to name a few. "Any time you add a new tool to a hospital, you first ask how the patient benefits, and then you ask how the system will benefit. This study will provide the much-needed results to address what we anecdotally know about how ultrasound technology improves internal medicine," says Dr. Tierney.
Another benefit of the program in terms of patient satisfaction is its use in keeping care transparent for patients, according to Dr. Tierney. "For example, if I have a cardiac patient with heart failure, I can show him at his bedside a picture of his heart squeezing versus a normal heart. It's a great tool for teaching patients about their diagnoses and helping them understand with live images what can otherwise be very complex problems to explain. If patients understand, they are much more likely to follow the recommendations you ask them to take on."
The IMBUS patient care improvement study has positioned portable ultrasound machines throughout Abbott Northwestern. For the first time, each hospital floor has a dedicated ultrasound machine, and staff carry additional mobile units on rounds. Ultrasound technology has even been implemented at the Abbott Northwestern outpatient clinics, with the number of faculty and residents learning the technology spreading from an original core of learners, according to Dr. Tierney.
Ultimately, the greatest value of Abbott Northwestern's IMBUS program is the daily impact it has on patient care. By providing real-time visualization right at the patient's bedside, portable ultrasound is a powerful tool for diagnosis and efficient treatment, and is an excellent way to advance the overall quality of the traditional physical exam. Dr Tierney notes that it's not just about improving HCAHPS scores. "We think you can really show cost savings, satisfaction gains and improved resource utilization here," he says. "These things lead to quality care, which leads to higher patient satisfaction. In the end, it is all about taking the best possible care of patients using the tools we have available. If ultrasound can fit in our little black bag, it is wrong for it not to be there."
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