Mobile ultrasound

– a report which focuses on the accessibility of the healthcare, national public economy and the environment

The Mobile Ultrasound service has been operating within Stockholm County Council for 8 years. This report describes the service from start up in August 2003 to December 2008. Around 700 patients have had ultrasound examinations in their homes in this period. The waiting time for a mobile ultrasound examination in this period has been very short, two of three patients being examined within 24 hours.

An evaluation of the operation of the mobile ultrasound service in this period of time has been carried out and has found that the service provides the County Council with significant transport cost savings and at the same time provides patients, their families and all healthcare personnel involved with major benefits.

Background

Stockholm County Council has, since August 2003, offered ultrasound examinations in the home to seriously ill or older patients. The service was begun in the spring of 2001, the technical developments that allowed patients to be diagnosed using the then completely new mobile ultrasound equipment, occurring at this time. A great deal of enthusiasm was however required to convince civil servants and decision makers that the County Council should allow patients in the county to receive the benefits provided by the new technology when this could be practically implemented.

A small enthusiastic group of doctors within the advanced home healthcare environment saw, at an early stage, the great benefits that the technology could provide their patients and these doctors straight away demanded mobile ultrasound examinations to ease the situations of their patients, their families and all healthcare personnel involved [1].

Some statistical data

Since the start in August 2003 and up to December 2008, 684 patients have been examined using mobile ultrasound. Only one examination is charged for where a number of organ groups are examined on a single patient per single visit. A total of 755 examinations were carried out.

373 patients were examined in the own home, while 311 patients were examined in different types of care institutions. The youngest patient was 27 and the oldest was 101.

The waiting time for a mobile ultrasound examination was short during the period. Two of three patients (66 %) were examined within 24 hours of the examination being ordered by the patient’s treating doctor. A final opinion was always submitted immediately after the examination.

Photo: Tommy Hvitfeldt

Ordering examinations

Mobile ultrasound examinations have been almost exclusively ordered solely by telephone by the treating doctor or a nurse. Only one referring doctor or nurse ordered an examination via the Internet. This must be interpreted as clearly indicating that a mobile telephone call directly to the radiologist was the preferred way to order by referring medical personnel. A cost free telephone consultation can also quickly exclude patients who will not benefit from an ultrasound examination. These patients are often referred to hospitals for examinations such as computed tomography or phlebography.

Equipment

The equipment consists of a mobile ultrasound equipment unit which is somewhat larger than a portable computer and weighs just 5 kg. Images are transferred to and are collected from a digital archive and can on request also be issued to the patient on a CD-ROM.

Common suspected medical conditions

The most common suspected medical conditions have been deep vein thrombosis (DVT). Of the 172 clinically suspected thromboses, 68 were confirmed while the suspicion could not be confirmed in 104 cases. Refer to [2] below for the diagnostic criteria for DVT using ultrasound. It was not unexpected that DVT was the most common suspected medical condition as most patients were bedridden.

Other common suspected medical conditions include the occurrence of ascites in the abdomen and hydronephrosis. Ultrasound guidance is particularly suitable for repeated ascites draining as scar formation can sometimes result in accretion and the formation of pockets. Ultrasound examinations often determine that there is no need to drain fluid in the abdomen, meaning that the patient does not need to be exposed to unnecessary puncture insertions.

Examinations carried out at specialist clinics

A number of specialist clinics at the large hospitals (i.e. Huddinge University Hospital and at Radiumhemmet) understood the benefits of patients being examined in their home at an early stage and have therefore sometimes requested an ultrasound examination before admitting a patient for specialist care. This primarily applies to patients with biliary passage diseases that result in cholestasis, patients with stent dysfunction or hydronephrosis. This has resulted in a reduction of the workloads upon the hospital’s emergency department and X-ray department.

Adaptation of the working method to patient requirements

The mobile ultrasound examination working method has since start up in 2003, been continuously adapted to the requests and needs of referring doctors and nurses, patients and families in an on-going consultation with the mobile ultrasound team. Patients who have had mobile ultrasound examinations, have experienced being examined in their own homes as very positive and all involved parties have welcomed that seriously ill patients have therefore been saved an often arduous journey to and from the hospital.

Radiologist travel

The radiologist in total travelled 23,660 km by car in the period August 2003 up to and including December 2008. The shortest journey was just a few a hundred metres from the base in Stockholm’s inner city. The longest journeys were to the Municipality of Nynäshamn and out to Stockholm’s archipelago. Many journeys were more than 100 km in total including the return.

Transport costs and the environment

Mobile ultrasound examinations carried out in the patient’s home provides the County Council with significant transport cost savings. This also is an initiative which benefits the environment. Transporting a bedridden patient by specially fitted out mobility buses or an ambulance to a hospital to be examined often requires 4 journeys by special vehicle and double manning for each examination. The two first journeys are to collect the patient from their home and drive them to the hospital, and then two additional journeys are required when returning the patient after the examination has been completed.

The radiologist’s journey to and from the patient’s home is by passenger car and maximum 2 journeys are required for the patient to be examined. Where the radiologist travels to several patients in one day, the journeys can be geographically organized so that the journeys for each examination are as short as possible.

Evaluation

The mobile ultrasound service is systematically presented in a Focus Report from 2005 titled ‘Mobile Ultrasound in the home and sheltered accommodation in Stockholm’s County Council area’. The focus report describes the medical program work carried out within Stockholm County Council in cooperation with representatives from Stockholm’s Medical Council.

The report contains an evaluation of the 14 first months of operation and includes the presentation of information that shows that the mobile ultrasound examinations have been cost effective for the County Council. Refer to the Focus report [3] for more information.

Stockholm, September 2009

Jaroslava Lander,
specialist in x-ray diagnostics, Laseradia AB,
doctor responsible for mobile ultrasound
in Stockholm County, 2003-2008

Bengt Lander,
Master of Laws, Laseradia AB,
project administrator for mobile ultrasound
in Stockholm County, 2003-2008

References

1. The Institute for Futures Studies. Essén A. Kvarboende och äldrevård i hemmet med modern teknik – vad hämmar utvecklingen? 2003;27.

2. SBU – The Swedish Council on Health Technology Assessment. Blodpropp – förebyggande, diagnostik och behandling av venös tromboembolism. En systematisk kunskapssammanställning. 2002;158(3.4):69.

3. Stockholm County Council. Medicinskt programarbete. Fokusrapport. Mobilt ultraljud i hemmet och äldreboende i SLL. 2005.

4. Mobilt ultraljud i hemmet. Stockholm County Council’s personnel magazine Sting. 2003;7/8:25.

5. Lander J, Mossige-Norheim S,  Linnarsson E. Mobilt ultraljud – undersökning i patientens hemmiljö. Läkartidningen. 2004;15-16:1435-1436.

6. Ultraljud hemma smidigt för äldre patienter. Dagens Medicin. 2004;34½ bilaga Medicinsk teknik, p.24.

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