E-Thesis 98 views 19 downloads
Can point-of-care ultrasound improve the current community diagnostic pathway for acute dyspnoea and suspected heart failure in older people? A feasibility study of comparative accuracy and implementation / SOPHIE MOOSAVI
Swansea University Author: SOPHIE MOOSAVI
DOI (Published version): 10.23889/SUthesis.66234
Abstract
Diagnosing heart failure (HF) is challenging in elderly, acutely dyspnoeic community patients with high frailty and multiple comorbidities. Current readily accessible diagnostic tools prevent a definitive diagnosis of HF at the point-of-care. There is growing evidence that novices can learn focused...
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Swansea, Wales, UK
2024
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| Institution: | Swansea University |
| Degree level: | Doctoral |
| Degree name: | Ph.D |
| Supervisor: | Rees, Emma. ; Fitzsimmons, Deborah. |
| URI: | https://cronfa.swan.ac.uk/Record/cronfa66234 |
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| Abstract: |
Diagnosing heart failure (HF) is challenging in elderly, acutely dyspnoeic community patients with high frailty and multiple comorbidities. Current readily accessible diagnostic tools prevent a definitive diagnosis of HF at the point-of-care. There is growing evidence that novices can learn focused point-of-care ultrasound (POCUS) to increase diagnostic accuracy of clinical examinations and improve immediate clinical management. Despite the abundance of data supporting POCUS by different users in different settings, there is a notable absence of attention to contextual complexities that influence implementation. This limits generalisability and leaves uncertainty regarding how and where POCUS should be placed to maximise clinical- and cost-effectiveness. This thesis examines whether nurse-led POCUS serves as a useful triage tool when added to the clinical examination of elderly patients with acute dyspnoea at risk of HF. It details a comprehensive approach to intervention development. An explanatory-sequential mixed-methods approach provided preliminary data regarding feasibility, acceptability, accuracy, and clinical impact of POCUS in the proposed context. It concludes that, following bespoke training, community nurses can accurately and reliably detect left ventricular systolic dysfunction and signs of pulmonary congestion using POCUS in elderly acutely dyspnoeic community patients with suspected HF. Adding POCUS improved the diagnostic accuracy of the assessment, reduced time-to-diagnosis, and could improve triaging of echocardiography referrals, without missing significant dysfunction. Despite contextual challenges of the home-setting, nurse-led POCUS was feasible in most patients and welcomed by nurses. Training and support were perceived as key determinants in implementation success while training interruption was seen as a major barrier. Preliminary findings suggest nurse-led POCUS as a triage tool has the potential to improve the current diagnostic pathway for elderly patients with suspected HF. It provides valuable data to support further larger-scale research and proposes refinements to research methods. POCUS has potential for more widespread clinical use, but exploration of contextual influences is pivotal in ensuring effective implementation in new contexts. |
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| Keywords: |
point-of-care ultrasound, hand-held, nurses, community, heart failure, comparative accuracy, implementation |
| College: |
Faculty of Medicine, Health and Life Sciences |