December 01, 2025
3 min read
Key takeaways:
- Patients who received an initial diagnosis with point-of-care ultrasonography (POCUS) vs. the standard of care spent fewer days in the hospital.
- Sonographers performed more POCUS evaluations than hospitalists.
Adults hospitalized with undifferentiated dyspnea had shorter stays and lower hospitalization costs if they received an initial diagnosis with cardiopulmonary point-of-care ultrasonography, according to study results.
These findings were published in JAMA Network Open.
“For the practicing hospitalist, the findings suggest that integrating point-of-care ultrasonography (POCUS) into routine dyspnea evaluation can improve clinical decision-making at the bedside, expedite discharges and reduce downstream costs,” Partho P. Sengupta, MD, DM, Henry Rutgers Professor and chief of cardiology at Rutgers Robert Wood Johnson Medical School and Robert Wood Johnson University Hospital, an RWJBarnabas Health facility, told Healio.
In a quality improvement study using a pragmatic, stepped-wedge randomized design, Sengupta and colleagues analyzed 208 adults (median age, 71 years; 58% women) with undifferentiated dyspnea in a U.S. tertiary care hospital to determine how use of cardiopulmonary POCUS by hospitalists and sonographers impacts length of stay (LOS) and costs vs. the standard of care.
Hospitalists and sonographers implemented a cardiopulmonary POCUS evaluation that captured five cardiac views and focused on a six-zone lung sweep into their assessment of these patients, according to the study. These specialists performed the preliminary interpretation of the exam, but a remote cardiologist did the final interpretation.
“While POCUS has been shown to improve bedside cardiopulmonary assessment, its use is heterogenous, and there has been limited prospective randomized evidence of its effect on hard outcomes such as hospital LOS and cost of care,” Sengupta told Healio.
“This study was prompted by that evidence gap and the need for pragmatic, real-world data on whether structured collaboration between cardiologists with hospitalist-driven POCUS could improve efficiency and reduce resource utilization in patients admitted with undifferentiated dyspnea,” Sengupta said.
According to a press release from Rutgers University, hospitalists were offered several hours of ultrasound training in order to be able to perform and interpret the exam in 10 to 15 minutes.
This study included 101 patients randomly assigned to receive an initial diagnosis with POCUS, of which 84 received POCUS, and 107 patients who received an initial diagnosis with the standard of care.
Results
Researchers found a mean LOS of 8.3 days among patients randomly assigned to receive POCUS, and this was significantly shorter than the mean of 11.9 days among those who received the standard of care (30.3% reduction; 95% CI, 5.5%-48.9%). Similarly, patients who received POCUS had a significantly shorter LOS vs. patients who received the standard of care (28.4% reduction; 95% CI, 2.9%-47.5%).
Before evaluating cumulative LOS and costs, the study reported that propensity score matching was carried out, resulting in 84 patients who received POCUS and 84 propensity-score matched patients who received the standard of care. Propensity score matching factored in age, sex, cardiac arrythmia, pulmonary comorbidities and venous thromboembolism.
Between the two sets of patients, the number of hospital bed-days was significantly lower among those who received POCUS (713 days vs. 959 days). Researchers highlighted that this difference of 246 hospital bed-days corresponded to a direct cost savings of $751,537 with POCUS, and per hospital bed-day saved, direct costs dropped by $3,055 with POCUS.
In terms of 30-day and 90-day readmission, the difference between the two groups at each point did not reach significance, according to the study.
When assessing a subgroup of 74 patients who had a documented performance of POCUS and its findings, researchers found an altered medical decision after POCUS in 30 patients.
“While we anticipated that POCUS would improve diagnostic accuracy, the degree of impact on system-level outcomes was striking,” Sengupta told Healio.
Sonographers performed more POCUS evaluations than hospitalists (67 evaluations [80%] vs. 17 evaluations [20%]), and Sengupta told Healio the small proportion performed by hospitalists was surprising.
According to the study, reasons for poor adoption among hospitalists included “insufficient training in image acquisition and interpretation, time constraints during rounds and a lack of incentivization to incorporate POCUS as a standard of care.”
Reflecting on these findings, Sengupta said they “highlight both the potential of POCUS to influence outcomes and the ongoing challenges of adoption, including training, time and workflow integration.”
Importance of findings, future research
As a whole, this study demonstrates the feasibility of embedding POCUS into everyday inpatient workflows, Sengupta told Healio.
“By modeling its impact on efficiency and cost, this study also provides health systems and policymakers with evidence to support broader POCUS adoption,” Sengupta said. “At a time of increasing pressure to optimize hospital resources, these findings position POCUS not only as a diagnostic tool but also as a value-based care intervention.”
Moving forward, Sengupta said multicenter studies with larger study populations are needed to confirm generalizability. Outcomes of interest should include LOS, cost, 30-day readmission, mortality and patient-reported satisfaction.
“Training strategies also warrant exploration — specifically, whether a structured curriculum can enable hospitalists to achieve similar outcomes without sonographer support independently,” Sengupta told Healio. “Implementation science approaches are also needed to address barriers such as training, time constraints and workflow integration.”
For more information:
Partho P. Sengupta, MD, DM, can be reached at partho.sengupta@rutgers.edu.
Perspective
I think POCUS at times helps to narrow differential and allow for a more focused treatment plan. I am not surprised by the findings, but one may ask if POCUS itself allows for more time with the patient than the standard of care. The history of POCUS was to approach with a pointed clinical question (ie, is there systolic dysfunction) that can be answered in a structured way.
Similar to above, these findings certainly help to narrow the focus and/or differential in my sick ICU patient cohort. A structured integration of POCUS into evaluation of a patient with dyspnea certainly has its merits and with proper education and training is a great complement to the history and physical.
I think the authors themselves rightfully identified the next step in this research, which is research into barriers and integration into current health care models and limiting steps for more durable adoption.
Parag Desai, MD
Disclosures: Desai reports no relevant financial disclosures.
Sources/Disclosures
Source:
Maganti K, et al. JAMA Netw Open. 2025;doi:10.1001/jamanetworkopen.2025.30677.
Reference:
Disclosures:
This study was sponsored by Butterfly Inc. Sengupta reports receiving consulting fees from HeartSciences and RCE Technologies; grants from the National Heart, Lung, and Blood Institute and National Science Foundation; grants or contracts from HeartSciences, MindMics and RCE Technologies; and holding patents with HeartSciences, Mayo Clinic and Rutgers Health outside the submitted work. Please see the study for all other authors’ relevant financial disclosures.
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