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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

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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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Published: Swansea, Wales, UK 2024
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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first_indexed 2024-05-02T11:06:25Z
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spelling v2 66234 2024-05-02 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 7e066ceecaf35aa68cb34a6dc0484bcf SOPHIE MOOSAVI SOPHIE MOOSAVI true false 2024-05-02 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. E-Thesis Swansea, Wales, UK point-of-care ultrasound, hand-held, nurses, community, heart failure, comparative accuracy, implementation 7 2 2024 2024-02-07 10.23889/SUthesis.66234 COLLEGE NANME COLLEGE CODE Swansea University Rees, Emma. ; Fitzsimmons, Deborah. Doctoral Ph.D 2024-05-02T12:33:20.9715468 2024-05-02T11:58:50.3232973 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Nursing SOPHIE MOOSAVI 1 66234__30229__4c5c3db79998446ca0fd22a234824c5e.pdf Moosavi_Sophie_PhD_Thesis_Final_Redacted_Signature.pdf 2024-05-02T12:12:38.4376849 Output 5222766 application/pdf E-Thesis – open access true Copyright: The Author, Sophie Moosavi, 2024. true eng
title 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
spellingShingle 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
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
author_id_str_mv 7e066ceecaf35aa68cb34a6dc0484bcf
author_id_fullname_str_mv 7e066ceecaf35aa68cb34a6dc0484bcf_***_SOPHIE MOOSAVI
author SOPHIE MOOSAVI
author2 SOPHIE MOOSAVI
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publishDate 2024
institution Swansea University
doi_str_mv 10.23889/SUthesis.66234
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Nursing{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Nursing
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description 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.
published_date 2024-02-07T12:33:20Z
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