376 Point-of-Care Ultrasound-First for the Evaluation of Urolithiasis in Patients Who Fit Choosing Wisely Criteria: National Cost Savings and Length of Stay Reduction

Abstract

Study ObjectivesChoosing Wisely guidelines recommend against ordering non-contrast computed tomography (NCCT) for patients with suspected urolithiasis who are under the age of 50 and have a history of recurrent kidney stones. Our primary objective was to estimate the annual national cost savings and reduction in emergency department (ED) length of stay (LOS) from using a point-of-care ultrasound (POCUS)-first approach for patients with urolithiasis meeting Choosing Wisely criteria.MethodsWe created and ran 1,000 trials of a Monte Carlo simulation. The study population included all patients who presented to the ED and were diagnosed with urolithiasis. Using this simulation, we modeled national cost savings in averted advanced imaging from a POCUS-first approach for urolithiasis. The model assumes that patients with indeterminate or negative POCUS studies underwent NCCT for further evaluation. We applied the same Monte Carlo model to estimate the reduction in ED LOS.ResultsUsing this model, a POCUS-first approach in our select patient population for diagnosing urolithiasis was estimated to save a mean (±SD) of $25.5 million (±$2.7 million) by avoiding 203,000 (±21,000) NCCT scans. This resulted in a national cumulative decrease of 205,000 (±874,000) ED bed-hours.ConclusionsIf adopted widely, a POCUS-first approach for suspected urolithiasis in patients who meet Choosing Wisely criteria could yield significant cost savings and reduction in ED LOS. Further research is needed to explore drivers of the lack of widespread adoption of this clinical workflow.No, authors do not have interests to disclose Study ObjectivesChoosing Wisely guidelines recommend against ordering non-contrast computed tomography (NCCT) for patients with suspected urolithiasis who are under the age of 50 and have a history of recurrent kidney stones. Our primary objective was to estimate the annual national cost savings and reduction in emergency department (ED) length of stay (LOS) from using a point-of-care ultrasound (POCUS)-first approach for patients with urolithiasis meeting Choosing Wisely criteria. Choosing Wisely guidelines recommend against ordering non-contrast computed tomography (NCCT) for patients with suspected urolithiasis who are under the age of 50 and have a history of recurrent kidney stones. Our primary objective was to estimate the annual national cost savings and reduction in emergency department (ED) length of stay (LOS) from using a point-of-care ultrasound (POCUS)-first approach for patients with urolithiasis meeting Choosing Wisely criteria. MethodsWe created and ran 1,000 trials of a Monte Carlo simulation. The study population included all patients who presented to the ED and were diagnosed with urolithiasis. Using this simulation, we modeled national cost savings in averted advanced imaging from a POCUS-first approach for urolithiasis. The model assumes that patients with indeterminate or negative POCUS studies underwent NCCT for further evaluation. We applied the same Monte Carlo model to estimate the reduction in ED LOS. We created and ran 1,000 trials of a Monte Carlo simulation. The study population included all patients who presented to the ED and were diagnosed with urolithiasis. Using this simulation, we modeled national cost savings in averted advanced imaging from a POCUS-first approach for urolithiasis. The model assumes that patients with indeterminate or negative POCUS studies underwent NCCT for further evaluation. We applied the same Monte Carlo model to estimate the reduction in ED LOS. ResultsUsing this model, a POCUS-first approach in our select patient population for diagnosing urolithiasis was estimated to save a mean (±SD) of $25.5 million (±$2.7 million) by avoiding 203,000 (±21,000) NCCT scans. This resulted in a national cumulative decrease of 205,000 (±874,000) ED bed-hours. Using this model, a POCUS-first approach in our select patient population for diagnosing urolithiasis was estimated to save a mean (±SD) of $25.5 million (±$2.7 million) by avoiding 203,000 (±21,000) NCCT scans. This resulted in a national cumulative decrease of 205,000 (±874,000) ED bed-hours. ConclusionsIf adopted widely, a POCUS-first approach for suspected urolithiasis in patients who meet Choosing Wisely criteria could yield significant cost savings and reduction in ED LOS. Further research is needed to explore drivers of the lack of widespread adoption of this clinical workflow.No, authors do not have interests to disclose If adopted widely, a POCUS-first approach for suspected urolithiasis in patients who meet Choosing Wisely criteria could yield significant cost savings and reduction in ED LOS. Further research is needed to explore drivers of the lack of widespread adoption of this clinical workflow.