Abstract
Purpose
While the clinical utility for Point-of-Care Ultrasound (POCUS) is well-established through its use in clinical practice to enhance diagnostic accuracy, expedite care, and improve patient interactions/communication, its impact on patient experience in outpatient consultative settings remains largely underexplored. We sought to evaluate patients’ experience and satisfaction by incorporating POCUS use during outpatient consultations.
Methods
In this prospective, cross-sectional survey study conducted in a consultative outpatient internal medicine practice, a continuous sample of 100 patients undergoing POCUS during routine medical evaluations participated. We assessed patient perspectives using a survey that was adapted from validated instruments. The following items were evaluated using the anonymized survey: the extent of patient understanding, the integration of POCUS into the consultation, its impact on patient-doctor communication, perceived quality of care, and overall patient experience.
Results
Most respondents felt better informed about their health (88%), more thoroughly examined (94%), and reported improved confidence in their physician’s assessment (92%) after the POCUS exam. In addition, POCUS was perceived as a natural part of the consultation (95%) and minimally burdensome (93%). Overall, 96% of study respondents agreed that POCUS improved their quality of care, and 98% described their experience as positive or very positive. Open-ended comments emphasized the immediacy of results, enhanced communication, and cost-effectiveness of the POCUS experience.
Conclusion
Incorporating POCUS in this environment improved patients’ perceptions of their physician, clinic, and overall care. These findings support the broader adoption of POCUS in similar clinical settings and its potential impact on healthcare delivery and patient satisfaction.
Introduction
Point-of-Care Ultrasound (POCUS) has become increasingly popular in numerous medical specialties for clinical decision-making and expediting diagnoses. Like traditional, radiology-based ultrasound, POCUS uses high-frequency sound waves generated by a transducer, which are reflected back to that transducer by body tissues to generate an image. The technology is considered exceptionally safe and does not use ionizing radiation like X-ray or Computed Tomography. In contrast to traditional radiology imaging, POCUS is conducted directly by the medical specialist during a consultative outpatient exam or at the bedside. Unlike traditional radiology ultrasound, POCUS is generally less comprehensive and focuses more on plan-of-care assessment and on whether additional imaging and tests are needed.
The use of POCUS during medical evaluation can streamline the diagnostic workflow and obviate the need for ancillary tests - expediting care and improving diagnostic accuracy.1,2 At other times, a normal bedside ultrasound can reassure the clinician and patient that the correct evaluation plan is in place. Clinicians also report enjoying using POCUS in their practice and have experienced improvements in patient interactions and engagement. 3 There are notable barriers that have delayed the adoption of POCUS by more clinicians using POCUS. Time constraints to attend certified training programs and time added to the initial medical assessment remain prohibitive barriers. Most POCUS exams can take less than 10 minutes for a trained and efficient clinician. 4 Streamlined and automated workflows can significantly reduce the administrative burden of incorporating POCUS. 5 Nonetheless, in busy outpatient practice, this remains difficult to implement6-8
Understanding the impact of POCUS and the patient experience is essential for physicians and advanced practitioners who strive to provide a positive patient experience that promotes well-being and improves health outcomes. Positive patient experience has also been shown to improve adherence to healthcare recommendations and outcomes.9-12 From the administrative perspective, patient experience survey results such as the Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS) are increasingly tied to reimbursement through value-based purchasing initiatives.13-15
Published literature identifies several important factors that generally influence patient satisfaction, which may apply specifically to POCUS use, including the quality of communication, perceived competency of health professionals, perceptions of care quality, and access to affordable care.12,16,17 It is important to note that, from the patient’s perspective, the duration of the appointment was not universally found to be an important factor, though there is some discrepancy in the research.18,19 Further research and shared learning on the relationship between using POCUS as a clinical decision-making tool and its impact on patient experience can be used to inform healthcare leaders as one of the means to improve patient experience in clinical practice.
The aim of our study was to understand how incorporating POCUS in our patient examinations would impact patient experience.
Methods
The Institutional Review Board (IRB) reviewed this cross-sectional survey study and determined to be exempt under section 45 CFR 46.101, item 2. During the study, all significant changes to study design and procedures were appropriately filed, reviewed, and approved by the IRB.
Setting
This study was conducted in a consultative outpatient general internal medicine practice at a destination medical center in the Midwest USA. The practice is divided into 3 main groups that serve as a primary service for our destination patients: Consultative Medicine, International Medicine, and Executive Health. Consultative Medicine serves private or publicly insured domestic patients seeking care for an undiagnosed condition or a second opinion regarding complex or multisystem disease. International Medicine serves a similar purpose for international patients, who may be sponsored by their country’s health department, privately insured, or self-pay. Executive Health provides streamlined preventive care with some chronic disease management for executives of large corporations. These services are billed through insurance with an annual premium that is either covered by the patient or their employer. Each care episode includes a 90-minute initial visit with an internist followed by necessary tests and specialist consultations, and a 30-minute follow-up to review findings, finalize the diagnosis, and provide clear recommendations. POCUS examinations were conducted at the initial 90-minute visit.
Study Population
At the start of the trial, each patient who underwent a POCUS exam as part of their evaluation was invited to participate in an anonymous survey, which continued until 100 participants consented and completed it. /]
Research Study Flow in Clinical Practice
Patients recruited in the study were seen in the consultative internal medicine practice. They are either self-referred or physician-referred from other medical institutions. Referral requests are reviewed and accepted by a board-certified internal medicine physician when the request is for a consultation offered in our facility for which access is currently available. Reasons for referral are broad and can include undiagnosed conditions, complex multisystem disease, serious or rare disease, second opinions on the management of common diseases that are poorly controlled, and basic medical evaluation and management of chronic disease and preventive health. Within the group of consultative internists, a small number of physicians regularly use POCUS as part of their daily practice. This is usually done during the medical evaluation using an institution-approved handheld device registered to the physician.
This prospective cross-sectional study enrolled a convenience sample of 100 patients seen in the consultative medicine division. After study initiation, the first 100 patients underwent a POCUS examination by one of the three clinicians co-authors, as a part of their medical evaluation and consented to participate in the study. Examination types included cardiac, pulmonary, hepatobiliary, renal, urinary, or soft tissue, and were indicated as part of the patient’s evaluation at the examiner’s discretion. After the encounter in which POCUS was used, the physician would briefly describe the study’s purpose and invite the patient to participate. The clinical and study teams would be blinded to the patient’s decision to consent and to the patient’s subsequent participation in the survey. The patients were given a smart tablet and instructed on how to navigate the digital document on it. The digital document was in REDCap®, and it consisted of two parts: consent and survey. After handing the patients the tablet and instructing them on how to navigate the document, the physician would leave and hence was blinded to the consent and survey responses. The first page of the document was the consent. At the end of the consent explanation, the patient had the option to participate or decline. If they declined, the application would close, and the encounter would be deemed complete. If they agreed to participate, the survey would open, and they could begin completing the survey. Once done, they left the tablet in the exam room for clinic staff to collect. The survey results were not identifiable or linked to any one individual.
Data Collection
Data was collected using the REDCap®20,21 web-based survey and database management application. Results were anonymized and stored on a secure server.
Survey Development and Administration
The survey instrument used was adapted, with permission, from one that was previously developed and published in Danish by Aakjær Andersen et al. The English version of the survey was published online 3 was reviewed and pilot tested by the three POCUS experts (clinical co-authors) for clarity and intent, and was adopted with minor grammatical changes for clarity. The overarching components of the survey were how well informed they were about the examination, how well it fit into their office visit, how it affected their impression of the quality of their care, and what effect it had on their overall experience in the clinic.
The survey was deliberately designed to be brief and low burden for participants to complete. It was anonymous (no patient identifiers), and all surveys were administered on a handheld tablet. A change from the original survey was that the version we adapted was delivered in REDCap® format. Survey results are summarized using frequency counts and percentages.
Results
Patient Characteristics (N=100*)
*Race and Ethnicity data was missing for 1 respondent.
Survey Results (N=100*)
*The number of participants who responded to a given question ranged from 99 to 100.
The open-ended comments showed that participants had a positive view of their POCUS experience, the physician who conducted it during the visit, and their overall experience (see Supplement Table).
Discussion
In this cross-sectional survey, patients reported a positive experience with the inclusion of point-of-care ultrasound (POCUS) during consultative outpatient visits. These findings confirm that most patients perceive POCUS favorably in the ambulatory setting, especially when used as a communicative and interactive tool rather than solely as a diagnostic modality. Our study contributes to the primary care–focused literature by evaluating patient experience in a referral-based consultative model that shares important features with advanced primary care and community-based outpatient practices.
Our findings align closely with patient-reported outcomes observed in community and general practice settings. In a large, multicenter Danish study of general practice POCUS, Andersen and colleagues found that patients overwhelmingly perceived POCUS as improving understanding of their health problem and emphasizing trust in the physician’s assessment. 3 Patients often noted that using POCUS during visits strengthened the doctor–patient relationship. In our study patients had comments such as “It (POCUS) made me feel I had a complete consultation” and that they had a “very professional and all-inclusive visit.” Patient comments not only included the examination itself but also mentioned broader aspects of clinician communication, confidence, and perceived quality of care. For example, ”The rapid assessment based on the exam gave me immediate peace of mind.” A list of these comments are available upon request.
Unlike many primary care settings where POCUS represents a novel enhancement in settings with limited resources (including time), our patients were evaluated in a Destination Medical Center consultative environment with high baseline expectations and satisfaction. Prior research suggests that patient experience in such settings is strongly influenced by clinician interpersonal skills, system efficiency, and institutional reputation.9,12,17,22 The fact that POCUS was associated with uniformly positive patient perceptions even in this “high-ceiling” environment suggests that its experiential benefits may be additive rather than redundant, a finding that complements rather than contradicts observations from community-based primary care.
Consistent with both primary care and inpatient mixed-methods research, our findings support the concept that the impact of POCUS extends beyond diagnostic clarification. Other studies in hospital settings describe a “positive care effect” associated with POCUS, mediated by real-time visualization, shared interpretation of images, and an enhanced therapeutic discussion. 23 Although our study did not formally assess the social or emotional impact of POCUS on patients, open-label comments suggested it shaped the overall impression of the exam. Similar benefits are seen in general practice, where patients feel more thoroughly examined and respected when POCUS is used in their routine care. 3 As POCUS adoption increases in standard health care visits, national surveys show rising clinician interest but ongoing challenges with equipment, training, time, and billing. 24 Our results suggest that, in addition to the potential benefits of detecting undiagnosed conditions and improving efficiency, providing a positive patient experience is an often-overlooked benefit of incorporating POCUS in outpatient care. Our findings support the concept that the impact of POCUS extends beyond diagnostic clarification.
Prior studies have also underscored the role POCUS plays in reducing diagnostic delays, improving access to care, and reducing health inequities in underserved communities by decreasing reliance on downstream imaging and specialty referrals. 7 Although our study population differs from typical primary care demographics, the positive response suggests POCUS is acceptable among diverse patients and can be used more broadly in community settings.
As with all research studies, especially surveys, our study has some inherent limitations. These limitations are inherent in our location and population, as well as the study design. Regarding our population, the racial and ethnic homogeneity of our sample limits generalizability to more diverse primary care populations. However, the inclusion of international patients introduces some heterogeneity in the patients’ experience with other prior healthcare. This suggests that positive perceptions of POCUS may transcend cultural differences in healthcare delivery. Additionally, the anonymous survey design precluded analysis of how specific POCUS applications influenced patient experience, a limitation shared by several prior outpatient studies.
The absence of a formal comparison group also limits causal inference. As in many primary care-based patient experience studies, isolating the effect of POCUS from other components of the clinical encounter is challenging. We therefore used the approach of having our patients use their prior healthcare experience as a reference point when completing the study survey. This methodology is used in many pragmatic patient-reported outcome research in ambulatory care.
Additionally, while our consultative practice differs from typical primary care practice, it shares core elements including a broad clinical scope, emphasis on patient-physician communication and diagnostic efficiency, and the importance of trust between doctor and patient. The concordance of our findings with observations from community general practice suggests that setting alone does not fully account for the positive patient response to POCUS.
Finally, it is important to note that our results may not be generalizable to the usual outpatient internal medicine practice. In many ways, our patient population and clinical environment are unique, as highlighted previously. Considering that all our patients can access and use the resources necessary to travel across state lines or internationally for an appointment, they are more likely to be educated and have a higher socioeconomic status than the average outpatient internal medicine population. One could imagine this unique practice and environment could influence patient perceptions in many ways. On one hand, preexisting perceptions of excellence may lead to a confirmation bias among patients, seeing this use of technology as further evidence of excellence without careful scrutiny of the value added. On the other hand, very positive baseline experience might lead to a ceiling effect, with little perceived value added with the use of POCUS in an already excellent experience. Those considerations in mind, our results do compare well to data reported from other environments.
Despite these limitations, our findings confirm that POCUS positively impacts the patient experience in outpatient settings. In our study, patients reported improved communication, greater understanding of their health, increased confidence in the clinicians, and a higher perceived quality of care. These outcomes reflect those seen in multiple settings and internationally.3,23,25-27 As primary care clinicians consider adopting POCUS, these benefits should be weighed alongside diagnostic and operational considerations. Supporting POCUS integration in primary care may lead to greater patient trust, engagement, and perceived quality of care, aligning closely with primary care’s goals.
Conclusion
Integrating POCUS into ambulatory care leads to positive patient experiences, with better communication, understanding, confidence, and perceived care quality. Previous studies in primary care support these benefits, showing that POCUS increases reassurance and engagement. As health systems focus on access, equity, and experience, POCUS may improve trust and care quality, making it valuable for the primary care setting. Additional research should assess its long-term effects in primary care, focusing on patient outcomes such as adherence to therapy.
Supplemental Material
Supplemental Material - Patient Perspectives on Point-of-Care Ultrasound Examinations in Consultative Outpatient Internal Medicine Practice
Supplemental Material for Patient Perspectives on Point-of-Care Ultrasound Examinations in Consultative Outpatient Internal Medicine Practice by Joshua Overgaard, Bright P. Thilagar, M. Nadir Bhuiyan, Darrell R. Schroeder, Shawn Fokken, Amy M Fratianni and Ivana T. Croghan in Journal of Primary Care & Community Health.
Footnotes
Acknowledgements
A special thanks to Associate Professor Aakjær Andersen for their help and guidance in the use and adaptation of the survey originally developed by their research group for their research. Another special thanks to all the patients who participated in this prospective survey; without their participation, this study would not have been possible.
Ethical Considerations
This study was determined to be EXEMPT under 45 CFR 46.101, item 2 by the Mayo Clinic Institutional Review Board which had ethical oversight for this study. In addition, the authors assert that all procedures contributing to this work comply with the ethical standards of the Mayo Clinic Institutional Review Board and its guidelines on human experimentation, in accordance with the Declaration of Helsinki of 1975, as revised in 2008.
Consent to Participate
In accordance with the Declaration of Helsinki, this study was reviewed and determined to be exempt under section 45 CFR 46.101, item 2. Mayo Clinic IRB approved informed consent waiver.
Author Contributions
All the authors participated in the study concept and design, analysis and interpretation of data, drafting and revising the paper, and have seen and approved the final version of the manuscript.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was partially funded by the Division of General Internal Medicine (Department of Medicine) and the Mayo Clinic Small Grant via the Mayo Clinic CTSA, under grant number UL1TR002377 from the National Center for Advancing Translational Sciences (NCATS), part of the National Institutes of Health (NIH). Data entry was conducted using REDCap® with partial support from the Center for Clinical and Translational Science award (UL1TR002377) from NCATS.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability Statement
All data supporting the study findings are contained within this manuscript.
Supplemental Material
Supplemental material for this article is available online.
References
Supplementary Material
Please find the following supplemental material available below.
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