A novel handheld point-of-care ultrasound device is being used in hospitals and primary care hubs as part of a new triaging system.
Royal Berkshire Hospital has equipped a team of doctors with the Butterfly iQ, a handheld ultrasound system that uses a single probe to scan the whole body and connects to a smartphone to show images in real-time.
Over the past six months, the emergency department and local GPs have used the device to perform lung ultrasounds on suspected COVID-19 patients without the need for chest X-ray imaging.
The device’s cloud storage system has allowed for healthcare professionals to save image scans and share them with colleagues. Butterfly Network, the company behind the device, says this feature will increase opportunities for collaboration amongst hospital staff.
Butterfly Network’s partnership with Royal Berkshire began in January of this year, prior to the outbreak of COVID-19 in the UK.
In the midst of the first wave, Royal Berkshire’s emergency department developed a new triaging system using the Butterfly iQ.Butterfly Network’s general manager for the UK & Ireland, Jeremy Hill says: “It has been a very interesting journey with Royal Berkshire.
Just after COVID hit us with wave one, they realised that scanning people’s lungs was an incredibly insightful tool. It allowed doctors to look at what was happening in patients and see if their condition was progressing to a COVID-type pneumonia.
“It worked really well for them. They started to share the message, get recognition from other hospitals and then liaise with their primary care colleagues.”
Royal Berkshire staff collaborated with GPs across Reading and Wokingham who had set up a ‘hot hub’ specifically for assessing potential COVID patients.
In order to prevent the unnecessary flow of patients from primary care to the hospital, hospital staff provided Butterfly iQ training for GPs working in the hub to identify coronavirus in the community. The pop-up COVID clinic then became the frontline for triaging patients.
According to intensive care medicine consultant at Royal Berkshire, Dr Andrew Walden, this is where the Butterfly devices “took off”.
Following a half-day training session, the hot hub immediately went into operation. In the first seven weeks, it saw 960 patients, with 36% suspected of having COVID-19. From these, only 46 patients were admitted to hospital.
Hill says: “It became this really neat, cutting-edge way to triage COVID patients in community under the guidance of secondary care and linking in with the hospital.
“It’s the first time that technologies have been used like that to link primary and secondary care and make a difference in the way that patients are managed. All of that was achieved under crisis settings in the thick of the first wave of COVID, which was pretty amazing.”
Dr Walden, who was a key figure in the development of the triage system, says the rapid adoption of the technology was in-part down to the receptiveness of Royal Berkshire’s management team.
Speaking to Health Tech World, Walden says: “When we proposed the idea to our chief operating officer and chief medical officer, they were incredibly receptive and said, ‘let’s go for it’.
“We also had a lot of support from the finance manager, so the finance was approved very quickly as well.
“The probes were put in place very quickly, so we went from concepts to starting the pathway within about six days. It was an amazing team effort.”
With flu season and the second wave of COVID fast-approaching, Walden says distinguishing between the two will be “tricky” but suspects that ultrasound could help with differentiating between COVID patients and flu patients.
Since the Butterfly iQ was rolled out at Royal Berkshire, the COVID crisis has accelerated adoption of the device in other hospitals around the country, including St Mary’s Hospital, Royal Free, Chelmsford, East Kent, Guys and St Thomas, Lewisham and Greenwich, Oxford University Hospital and The Royal London.
Hill says: “We have a good spectrum across all types of hospitals, including teaching hospitals, general hospitals, small, large, academic and district hospitals.”
“Waiting to get a test is a long-standing problem with medicine. It creates inefficiency, frustration, expense, and it lowers quality.
“COVID gave everybody the opportunity to see the power of ultrasound. It has the ability to detect pneumonia, heart failure, gallstones, kidney stones. With point-of-care ultrasound, doctors can pull it out of their pocket and have an instant answer.
“That efficiency is what all of us crave in medicine, both the NHS from a financial perspective, but all the patients out there that stand frustrated with waiting to see a doctor and waiting to get a test.
Butterfly Network was founded in 2011 and following several years of R&D, the Butterfly iQ device was launched in late 2018, becoming available in the UK in 2019.
The company says it has reinvented the scan by “putting ultrasound on a chip” and connecting the device to the user’s smartphone.
According to the company, the Butterfly iQ is the only single device that can provide image scanning for the entire body. Traditional ultrasound systems require a different wand to scan different areas of the body.
Dr John Martin, chief medical officer at Butterfly Network, says: “Ultrasound’s broad applicability to individual physicians’ hands has been limited by the expense and complexity. Ultrasound machines, like CT scans and MRIs are a limited resource.
“By putting ultrasound on a chip, it dramatically lowers the cost of producing these ultrasound systems.
“With the Butterfly iQ, you have a single device that plugs into your phone and can scan the entire body, and it’s only 2000 US dollars.”
Butterfly Network has big ambitions for its devices and anticipates mass adoption throughout the healthcare system, which Hill says will be “transformative”.
The company believes the cloud system will also be a gamechanger for the sector. Hill says: “Doctors will begin to realise that they can not only diagnose somebody there and then, but when they’re stuck, they can also talk immediately to somebody that’s an expert in that speciality within the hospital.
“Connecting with colleagues, sharing and collaborating is going to become a massive thing. It’s going to save lives, cut down treatment times, procedure times and diagnosis times as well.”
Dr Martin goes as far to say that point-of-care ultrasound could eventually replace the stethoscope.
He says: “I think it is going to be the doctors’ primary tool and if you really want to look out into the future, patients are going to be able to scan themselves.”
Last year, Dr Walden was involved with a debate regarding whether point-of-care ultrasound should replace the stethoscope, which was published in the BMJ in August 2019.
“It should be included as part of the clinical examination,” Walden says, “but I don’t necessarily want to use ultrasound on every single patient, because although it’s very accessible, it’s sometimes quicker just to use the stethoscope.”
Whether ultrasound will replace the stethoscope or not, Royal Berkshire has begun to integrate the devices into other departments across the hospital, including intensive care, acute medicine, respiratory and cardiology.
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