The following is a summary of “POCUS-first for nephrolithiasis: A Monte Carlo simulation illustrating cost savings, LOS reduction, and preventable radiation,” published in the December 2023 issue of Emergency Medicine by Barton, et al.

For a study, researchers sought to estimate the national annual cost savings achieved by implementing a point-of-care ultrasound (POCUS)-the first approach for patients with suspected nephrolithiasis who meet Choosing Wisely criteria. Secondary objectives included estimating reductions in emergency department (ED) length of stay (LOS) and preventable radiation exposure.

A Monte Carlo simulation was developed using available data on the frequency of ED visits for nephrolithiasis and eligibility for a POCUS-first approach. The study population consisted of all ED patients diagnosed with nephrolithiasis. Through 1,000 simulation trials, national cost savings from averted advanced imaging were estimated. The same model was applied to predict reductions in ED LOS and preventable radiation exposure.

The simulation indicated that implementing a POCUS-first approach for nephrolithiasis meeting Choosing Wisely guidelines could lead to a mean cost savings of $16.5 million (±$2.1 million) annually, avoiding 159,000 (±18,000) NCCT scans. This approach also resulted in a cumulative decrease of 166,000 (±165,000) annual bed hours in ED LOS nationwide. Moreover, there was a cumulative reduction in radiation exposure of 1.9 million person-mSv, potentially preventing 232 (±81) excess cancer cases and 118 (±43) excess cancer deaths annually.

Adopting a POCUS-first approach for suspected nephrolithiasis in patients meeting Choosing Wisely criteria could yield substantial national cost savings, along with reductions in ED LOS and preventable radiation exposure. Further investigation was warranted to identify barriers to the widespread adoption of this clinical workflow and explore its benefits in other patient populations.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723004989