Integrating Point-of-Care Ultrasound in Emergency Department Triage

A prospective cohort evaluated the operational introduction of point-of-care ultrasound into ED triage and found measurable effects on triage coding and workflow.

This single-center prospective cohort enrolled 312 patients across two enrollment phases and compared standard triage with a POCUS-implemented protocol. Endpoints included triage duration, net reclassification index (NRI), and nurse-reported impact. Overall median triage time was 180 seconds; POCUS increased median evaluation time by about 90 seconds (p<0.01). Net reclassification improvements were observed across urgency categories (emergent ~33.3%, urgent ~8%, less urgent ~5%, non-urgent ~25%).

The findings describe a clear trade-off: modestly longer triage evaluations in exchange for measurable gains in triage-code reclassification and potential care-path optimization.

Experienced triage nurses used handheld devices to perform short, targeted scans, raising per-patient triage time without substantially changing overall discharge rates. Nurses performed focused lung, vascular, and limited abdominal scans.

In roughly 20–30% of POCUS cases, staff reported that imaging would have changed the assigned triage code, although most patients remained discharge-bound. Triage POCUS appears most valuable when presentations suggest respiratory compromise, suspected DVT, or limited abdominal pathology that alters immediate prioritization.

Nurses in the study had prior POCUS exposure (a baseline 4-hour course plus >150 prior scans) and received an additional 4-hour focused session before enrollment.