Written by Chris Thom
Spoon Feed
In this cluster-randomized study of hospitalized patients with undifferentiated dyspnea, POCUS utilization was associated with shorter length of stay and reduced costs.
Inpatient POCUS improves LOS and could improve ED boarding
This was a step-wedge cluster-randomized study of undifferentiated dyspnea inpatients at a single tertiary care center in the US. Adult patients with undifferentiated dyspnea were enrolled. 102 patients were randomized into the POCUS arm and 114 in the control arm. Attending hospitalists or sonographers would perform heart and lung POCUS on the first day of admission.
POCUS utilization was associated with a 30% reduction in LOS (95%CI 5.5%-49%), with a mean LOS of 8.3 days in the POCUS arm and 11.9 days in the control group. Across the cohort, POCUS utilization was associated with a total reduction of 246 hospital bed-days, which led to an estimated cost savings of $751,537. The majority of patients in both arms had a discharge diagnosis of heart failure (65% overall). There was no difference between groups in hospital re-admissions within 30 days.
How does this change my practice?
Extensive literature has established the benefit of POCUS on ED length of stay. This study extends this to the inpatient arena. While there are some limitations, including industry funding and a single-center design, our inpatient POCUS colleagues may benefit from leveraging this data to gain leadership support for their own POCUS deployments. POCUS is a proven tool in undifferentiated dyspnea, and it has the potential to cause management changes and inpatient LOS reductions.
POCUS pro-tips and clips
The assessment of interstitial fluid (B-lines) on lung ultrasound is easy, both from an acquisition and interpretation standpoint. If you ever need to convert a POCUS skeptic, this application is a preferred vehicle to do so. In more severe cases of interstitial fluid, you won’t miss the vertically oriented, echogenic B-lines and will see these from almost any anatomical thoracic area. In more subtle or mild cases, you will find more sensitivity when looking in more dependent lung zones (e.g. more lateral or posterior on a supine patient).
Source
Cardiopulmonary Point-of-Care Ultrasonography for Hospitalist Management of Undifferentiated Dyspnea. JAMA Netw Open. 2025 Sep 2;8(9):e2530677. doi: 10.1001/jamanetworkopen.2025.30677. Erratum in: JAMA Netw Open. 2025 Oct 1;8(10):e2543834. doi: 10.1001/jamanetworkopen.2025.43834. PMID: 40911308; PMCID: PMC12413653.
