Abstract
IMPORTANCE: The association of cardiopulmonary point-of-care ultrasonography (POCUS) with length of stay (LOS) and hospitalization costs for patients admitted to internal medicine wards remains uncertain. OBJECTIVE: To evaluate a collaborative implementation model involving hospitalists, sonographers, and a remote cardiologist for integrating cardiopulmonary POCUS into the assessment of adult patients (≥18 years) hospitalized with undifferentiated dyspnea, and to assess its association with LOS and hospitalization costs. DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study employed a type 1 effectiveness-implementation hybrid design using a 6-month stepped-wedge cluster randomized approach, conducted at a tertiary care hospital in the US between December 7, 2023, and July 2, 2024, to compare the standard-of-care (control) with the intervention group. Patients were eligible for inclusion if they were older than 18 years, admitted to 1 of the 5 internal medicine teaching hospitalist teams, and presented with undifferentiated dyspnea. EXPOSURE: Structured cardiopulmonary POCUS examinations performed by hospitalists and/or sonographers, integrated into routine assessment of dyspnea. MAIN OUTCOMES AND MEASURES: Study outcomes (LOS and hospitalization costs) were presented using the reach, effectiveness, adoption, and implementation (RE-AIM) framework. RESULTS: The study reached 208 patients (median [IQR] age, 71 [59-80] years; 121 female [58%]), including 107 in the control group and 101 in the POCUS group. The implementation of cardiopulmonary POCUS was associated with a 30.3% (95% CI, 5.5%-48.9%) reduction in expected LOS (mean [SD] LOS, 8.3 [5.2] days for the POCUS group vs 11.9 [7.5] days in the control group). Based on cumulative assessments, POCUS use was associated with a total reduction of 246 hospital bed-days and direct cost savings of $751 537, with an incremental cost-effectiveness ratio of $3055 per hospital bed-day saved. POCUS altered medical decisions in 30 patients (35%). Adoption and implementation of POCUS by hospitalists remained limited despite comprehensive training, with only 20% of POCUS evaluations (17 patients) being performed independently, while the majority relied on sonographers. CONCLUSIONS AND RELEVANCE: In this quality improvement study, cardiopulmonary POCUS implementation was associated with a significant reduction in LOS and hospitalization costs, highlighting its clinical utility and potential for improved hospital efficiency; however, limited adoption by hospitalists underscores the need for ongoing training, support, and professional incentives to strengthen competency and motivation. Multicenter studies are needed to evaluate tailored educational models and sustainable support systems to optimize long-term integration of POCUS into routine practice.