0029 Single-cell and spatial profiling reveals a pathogenic cDC2A-CXCL13+ CD8+ T-epithelial cell communication network in lichen planus

Journal of Investigative Dermatology · 2025-07-21

Impact of worklist selection on point-of-care ultrasound workflow – a quality improvement project

BMC Health Services Research · 2025-01-14

BACKGROUND: Research demonstrates that Point-of-care ultrasound (POCUS) improves clinical outcomes for patients. Improving clinician satisfaction with POCUS should promote utilization into everyday practice, leading to improved clinical outcomes. Despite this benefit, there are still barriers to use including POCUS workflow. This project was undertaken to improve the functionality of the existing POCUS workflow and move toward an "encounter-based" system by automating worklist generation. It aimed to streamline the POCUS workflow, primarily determine if there was improved clinician satisfaction with the new workflow, and secondarily determine the change in revenue generation from decreased errors in data entry. METHODS: A new workflow was created which automatically populated every registered Emergency Department (ED) patient into the worklist upon patient registration. Clinician feedback on their use of the new workflow was sought via survey after implementation. The number of medical record number (MRN) entry errors prior to and following implementation was manually reviewed and calculated. RESULTS: There was a strong preference for the new workflow, with 36 of 38 (94.7%) clinicians finding it to be more convenient and 37 of 38 (97.4%) finding it to be preferable to use compared to the old workflow. Implementation also resulted in a 36% reduction in database studies containing an MRN data entry error. CONCLUSIONS: An "encounter-based" workflow is strongly preferred over manual data entry for POCUS workflow among clinicians. Additionally, there was no cost to the intervention and the total data entry errors were significantly reduced, allowing for improved quality review and increased revenue.

Applications of ocular point-of-care ultrasound assessment in the emergency setting: a scoping review

Clinical and Experimental Emergency Medicine · 2024-09-05 · 1 citations

OBJECTIVE: To evaluate the current body of literature pertaining to the use of ocular point-of-care ultrasound (POCUS) in the emergency department (ED). METHODS: A comprehensive literature search was conducted on Scopus, Web of Science, MEDLINE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Inclusion criteria were studies written in English and primary clinical studies involving ocular POCUS scans in an ED setting. Exclusion criteria were nonprimary studies (e.g., reviews or case reports), studies written in a non-English language, nonhuman studies, studies performed in a nonemergency setting, studies involving non-POCUS ocular ultrasound modalities, or studies published more than 10 years prior. Data extraction was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. RESULTS: The initial search yielded 391 results with 153 duplicates. Of the remaining 238 studies selected for retrieval and screening, 24 met the inclusion criteria. These 24 included studies encompassed 2,448 patients across prospective, retrospective, cross-sectional, and case series study designs. The majority of included studies focused on the use of POCUS in the ED to measure optic nerve sheath diameter as a proxy for papilledema and metabolic aberrations, while a minority of studies used ocular POCUS to assist in the diagnosis of orbital fractures or posterior segment pathology. CONCLUSION: The vast majority of studies investigating the use of ocular POCUS in recent years emphasize its utility in measuring optic nerve sheath diameter and fluctuations in intracranial pressure, though additional outcomes of interest include pathology of the posterior segment, orbit, and globe.

Examining the Durability of an Inexpensive Intervention for Improving Point-of-care Ultrasound Documentation Rates.

PubMed · 2024-09-20

Background: Point-of-care ultrasound (POCUS) has become a widely used diagnostic tool in emergency departments (EDs), and proper documentation is essential for both patient safety and reimbursement. POCUS is often underdocumented, and therefore, underbilled, by emergency medicine physicians. The absence of POCUS documentation can result in significant revenue loss for both providers and hospital administration. Methods: . and primarily examines POCUS documentation rates for a 15-month billing period following the initial intervention of a personalized e-mail reminder. Data included rates of documented and phantom scans from three separate 11-day periods (April 2019, July 2019, and July 2020) after the performance feedback intervention in March 2019. Results: Documentation rates steadily declined from April 2019 to July 2020 following the intervention, with the highest success rate being immediately after the e-mail intervention. Conclusion: This study demonstrates that there is limited durability to a single e-mail reminder as an intervention to improve POCUS documentation in the ED and suggests that there is a need for repeated interventions to prevent deterioration of documentation rates.

Artificial Intelligence (AI) Applications for Point of Care Ultrasound (POCUS) in Low-Resource Settings: A Scoping Review

Diagnostics · 2024-08-01 · 46 citations

Advancements in artificial intelligence (AI) for point-of-care ultrasound (POCUS) have ushered in new possibilities for medical diagnostics in low-resource settings. This review explores the current landscape of AI applications in POCUS across these environments, analyzing studies sourced from three databases-SCOPUS, PUBMED, and Google Scholars. Initially, 1196 records were identified, of which 1167 articles were excluded after a two-stage screening, leaving 29 unique studies for review. The majority of studies focused on deep learning algorithms to facilitate POCUS operations and interpretation in resource-constrained settings. Various types of low-resource settings were targeted, with a significant emphasis on low- and middle-income countries (LMICs), rural/remote areas, and emergency contexts. Notable limitations identified include challenges in generalizability, dataset availability, regional disparities in research, patient compliance, and ethical considerations. Additionally, the lack of standardization in POCUS devices, protocols, and algorithms emerged as a significant barrier to AI implementation. The diversity of POCUS AI applications in different domains (e.g., lung, hip, heart, etc.) illustrates the challenges of having to tailor to the specific needs of each application. By separating out the analysis by application area, researchers will better understand the distinct impacts and limitations of AI, aligning research and development efforts with the unique characteristics of each clinical condition. Despite these challenges, POCUS AI systems show promise in bridging gaps in healthcare delivery by aiding clinicians in low-resource settings. Future research endeavors should prioritize addressing the gaps identified in this review to enhance the feasibility and effectiveness of POCUS AI applications to improve healthcare outcomes in resource-constrained environments.

Examining the Durability of an Inexpensive Intervention for Improving Point-of-care Ultrasound Documentation Rates

Journal of Medical Ultrasound · 2024-09-20 · 1 citations

Abstract Background: Point-of-care ultrasound (POCUS) has become a widely used diagnostic tool in emergency departments (EDs), and proper documentation is essential for both patient safety and reimbursement. POCUS is often underdocumented, and therefore, underbilled, by emergency medicine physicians. The absence of POCUS documentation can result in significant revenue loss for both providers and hospital administration. Methods: This study is a follow-up study to the manuscript published by Lahham et al . and primarily examines POCUS documentation rates for a 15-month billing period following the initial intervention of a personalized e-mail reminder. Data included rates of documented and phantom scans from three separate 11-day periods (April 2019, July 2019, and July 2020) after the performance feedback intervention in March 2019. Results: Documentation rates steadily declined from April 2019 to July 2020 following the intervention, with the highest success rate being immediately after the e-mail intervention. Conclusion: This study demonstrates that there is limited durability to a single e-mail reminder as an intervention to improve POCUS documentation in the ED and suggests that there is a need for repeated interventions to prevent deterioration of documentation rates.

O-C2) The Association of Image Gain Intensity to the Accuracy of Point-of-care Ocular Ultrasound

Western Journal of Emergency Medicine · 2024-01-19

Author(s): Lee, Albert; Saadat, Soheil; Gibney, Ryan; Nash, Brenda; Perez-Moreno, Nora; Whited, Matthew; Baker, Jessa; Chang, Melissa; Finney, Nicole; Gupta, Shreya; Sarsour, Reem; Rowland, Jonathan; Fox, John Christian

Comparison of Emergency Department Disposition Times in Adult Level I and Level II Trauma Centers

Western Journal of Emergency Medicine · 2024-10-22 · 4 citations

Introduction: The efficient utilization of resources is a crucial aspect of healthcare, particularly in both Level I and Level II American College of Surgeons (ACS)-verified trauma centers. The effect of resource allocation on emergency department length of stay (ED-LOS) of trauma patients has remained under-investigated. As ED crowding has become more prevalent, especially at quaternary care centers, an evaluation of the potential disparities in ED-LOS between Level I and Level II trauma centers is warranted. We hypothesized a longer ED-LOS at Level I centers compared to Level II centers. Methods: We queried the 2017–2021 Trauma Quality Improvement Process (TQIP) database for trauma patients ≥18 years of age presenting to either a Level-I or -II center. The TQIP defines ED-LOS as the time from arrival until the time an ED disposition (admission or discharge) order is written. We excluded transferred patients and those with missing data regarding ACS trauma center verification level. We performed bivariate analyses, as well as subgroup analyses based on location of disposition. Results: Of 2,225,067 trauma patients, 59.3% (1,318,497) received treatment at Level I centers. No significant differences were found in Injury Severity Scores between patients admitted to the operating room or non-intensive care unit (ICU) locations, or discharged home from Level-I and -II centers (all P < 0.05). The ED-LOS for trauma patients was longer at Level-I centers for all patient categories: overall (198 vs 145 minutes [min], P < 0.001), discharged home (286 vs 160 min, P < 0.001), non-ICU admissions (234 vs 164 min, P < 0.001), and those requiring surgery (126 vs 101 min, P < 0.001). Conclusion: Even when treating patients with similar injury severity, trauma patients at Level I trauma centers had longer ED-LOS compared to Level II centers, irrespective of the patients’ final disposition (surgery, non-ICU admission, or discharge). To optimize resource utilization and alleviate ED saturation, further research must delve into the underlying causes of these discrepancies to identify best practices and solutions.

Erector spinae plane block for intractable, nonsurgical abdominal pain: a scoping review

Clinical and Experimental Emergency Medicine · 2024-03-15 · 8 citations

Abdominal pain is one of the most common presenting chief complaints in the emergency department. Erector spinae plane block (ESPB) is an ultrasound-guided nerve block with proven effectiveness in treating visceral and somatic abdominal pain. Despite the increasing popularity of ESPB, its role in the management of nonsurgical abdominal pain has not yet been characterized. Our scoping review aims to synthesize current knowledge on the safety and efficacy of ESPB in the management of patients experiencing intractable, nonsurgical abdominal pain. We searched PubMed and Scopus to evaluate the existing literature on ESPB for nonsurgical abdominal pain. A total of 14 journal articles were included: 12 case-based studies, one systematic review, and one narrative review. All cases described the successful use of ESPB in treating abdominal pain refractory to oral or intravenous analgesic medications, and no complications were reported in any cases. This scoping review provides support for the use of ESPB to manage intractable, nonsurgical abdominal pain. ESPB has demonstrated efficacy in alleviating various conditions such as functional abdominal pain, renal colic, pancreatitis, herpetic pain, and cancer-related pain. Theoretical risks such as pneumothorax, bleeding, and infection are possible, although the studies reviewed did not report such complications.

Using a Linear Probe Ultrasound for the Detection of First-Trimester Pregnancies in the Emergency Department

Diagnostics · 2023-08-01 · 3 citations

Linear probe point-of-care ultrasound (LPUS) presents a less invasive alternative for identifying intrauterine pregnancies (IUPs) compared to usual practice (transabdominal (TAUS) or transvaginal (TVUS) ultrasound). TAUS and TVUS can be invasive or produce lower-resolution images than LPUS. The purpose of this study is to determine whether a linear probe alone can identify first-trimester IUPs. A convenience sample of 21 patients were enrolled at the University of California Irvine ED during a 7-month period. The inclusion criteria were English- or Spanish-speaking women (≥18 years) in their first trimester of pregnancy (≤12 weeks pregnant) with a body mass index (BMI) of <35. The exclusion criteria were psychiatric, incarcerated, or cognitively impaired patients. An ED physician performed LPUS and ordered a confirmatory ultrasound. The 21 patients enrolled had a mean age of 28.6 ± 6.60 years, BMI of 26.6 ± 5.03, and gestational age of 7.4 ± 2.69 weeks. Considering the 95% confidence interval, we are 97.5% confident that the sensitivity and specificity of LPUS to identify IUPs does not exceed 67.1% and 93.2%, respectively. Our pilot data did not demonstrate that LPUS can independently visualize IUPs in first-trimester patients.