Coverage of Emergency After-Hours Ultrasound Cases

2011

Background: Survey data over the last several decades suggests that emergency department (ED) access to diagnostic ultrasound performed by the radiology department is unreliable, particularly outside of regular business hours. Objective: To evaluate the association between the time of day of patient presentation and the use of diagnostic ultrasound services in United States (U.S.) EDs. Methods: This was a cross-sectional study of ED patient visits using the National Hospital Ambulatory Medical Care Survey for the years 2003 to 2005. Our main outcome measure was the use of diagnostic ultrasound during the ED patient visit as abstracted from the medical record. We performed multivariate analyses to identify any association between ultrasound use and time of presentation for all patients, as well as for two subgroups who are more likely to need ultrasound as part of their routine workup: patients at risk of deep venous thrombosis, and patients at risk for ectopic pregnancy. Results: During the three-year period, we analyzed 110,447 patient encounters, representing 39 million national visits. Of all ED visits, 2.6% received diagnostic ultrasound. Presenting to the ED "off hours" (defined as Monday through Friday 7pm to 7am and weekends) was associated with a lower rate of ultrasound use independent of potential confounders (odds ratio [OR] 0.73, 95% confidence interval [CI]: 0.65-0.82). Patients at increased risk of deep venous thrombosis who presented to the ED during "off hours" were also less likely to undergo diagnostic ultrasound (OR 0.34, 95% CI: 0.15-0.79). Similarly, patients at increased risk of ectopic pregnancy received fewer diagnostic ultrasounds during "off hours" (OR 0.56, 95% CI 0.35-0.91). Conclusion: In U.S. EDs, ultrasound use was lower during "off hours," even among patient populations where its use would be strongly indicated. [

The western journal of emergency medicine, 2010

To determine whether a medical student emergency ultrasound clerkship has an effect on the number of patients undergoing ultrasonography and the number of total scans in the emergency department. We conducted a prospective, single-blinded study of scanning by emergency medicine residents and attendings with and without medical students. Rotating ultrasound medical students were assigned to work equally on all days of the week. We collected the number of patients scanned and the number of scans, as well as participation of resident and faculty. In seven months 2,186 scans were done on the 109 days with students and 707 scans on the 72 days without them. Data on 22 days was not recorded. A median of 13 patients per day were scanned with medical students (CI 12-15) versus seven (CI 6-9) when not. In addition, the median number of scans was 18 per day with medical students (CI 16-20) versus eight (CI 6-10) without them. There were significantly more patients scanned and scans done when ...

Ultrasound in Medicine & Biology, 2003

Journal of Ultrasound in Medicine, 2006

Objective. Two sonographers were trained to help manage an abrupt, permanent increase in the number of ultrasound examinations in our department. Called "ultrasound practitioners," they functioned as physician assistants and triaged 20 to 30 cases per day, allowing the cases to be batch read at a formal reading at day's end. We report our first-year experience with this program. Methods. Two sonographers with 10 and 30 years of experience, respectively, were trained to triage and dictate cases. Once trained, they triaged the cases of 20 to 30 patients per day. Reports were predictated with voice recognition technology. A radiologist was always readily available to provide support, and consultation with a radiologist was always obtained for the infrequent verbal reports that were requested. Reports from the practitioner were graded subjectively on a 4-point scale for the first year, according to the modification required at formal readout (A, no change; B, minor change not affecting patient care; C, moderate change not affecting care in a dramatic way; and D, major change markedly affecting care). Results. Practitioner 1 monitored the examinations of 2858 patients. The graded report results were as follows: A, 96.2%; B, 3.5%; C, 0.3%; and D, 0.00%. Practitioner 2 monitored the examinations of 2825 patients. The graded report results were as follows: A, 96.1%; B, 3.6%; C, 0.2%; and D, 0.00%. There were no category D reports. Conclusions. The results far exceeded expectations, with a very low rate of category B and C reports and an absence of category D reports. The practitioners allowed the cases of 20 to 30 patients to be batch read by the existing radiologist staff at the end of the day.

American Journal of Roentgenology, 2012

At the same time, many smaller academic and community practices have chosen to use a variety of for-profit distant services to fill the void [7-9]. The teleradiology model is in some ways similar to the traditional academic approach to emergency department coverage (i.e., a generalist preliminary interpretation followed by a next day official final interpretation). This staggered radiology review has engendered similar concerns regarding discordance and care. It is self-evident that patients and physicians benefit from having the best possible reading at the moment of care. Academic radiology groups have struggled to answer these demands. The pool of faculty members who are willing to cover after hours work and who have the expertise to cover all

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2006

Two sonographers were trained to help manage an abrupt, permanent increase in the number of ultrasound examinations in our department. Called "ultrasound practitioners," they functioned as physician assistants and triaged 20 to 30 cases per day, allowing the cases to be batch read at a formal reading at day's end. We report our first-year experience with this program. Two sonographers with 10 and 30 years of experience, respectively, were trained to triage and dictate cases. Once trained, they triaged the cases of 20 to 30 patients per day. Reports were predictated with voice recognition technology. A radiologist was always readily available to provide support, and consultation with a radiologist was always obtained for the infrequent verbal reports that were requested. Reports from the practitioner were graded subjectively on a 4-point scale for the first year, according to the modification required at formal readout (A, no change; B, minor change not affecting patien...

Open Access Emergency Medicine, 2014

Background: Academic emergency departments (EDs) are often reliant on preliminary interpretation by radiology residents for after-hours computed tomography (CT) images. Identifying residents' errors in diagnostic interpretation and ensuring appropriate contact with affected patients are areas of continuing concern. Objective: The Mount Sinai Hospital ED and Medical Imaging Department in Toronto, Canada sought to examine the clinical impact of extending reporting hours of senior attending radiologists for ED patients undergoing CT imaging. Methods: All evening CT studies were read by the on-call sub-specialist staff radiologist before 10 pm; while studies done after 10 pm were read by 8 am, permitting review of final reports by the ordering ED physician. A retrospective review of radiology and ED metrics was performed on ED patients undergoing CT imaging 12 weeks before and 12 weeks after implementation of the extended reading hours. Results: In the 12 weeks prior to implementation of extended senior attending radiologist coverage, 871 CT scans were performed as compared to 944 CT scans after implementation. Time from performance of CT scan to obtaining a dictated report decreased from 10.4 hours to 2.8 hours (P,0.001), and time from performance of CT scan to report verification by the radiologist decreased from 29.7 hours to 9.4 hours (P,0.001). There were no statistically significant changes in ED length of stay, rates of admission, or rates of consultation. However, there was a significant reduction in (median) time taken for ED physicians to resolve discrepant reports in the radiology information system queue (20.7 hours versus 13.3 hours, P,0.001). Conclusion: The extension of reporting hours reduced the time for ED physicians to review discrepant reports, while balancing educational needs of residents. This project has been considered a success by stakeholders and has now been implemented on a permanent basis.

The Journal of Emergency Medicine, 2010

e Abstract-Background: Emergency Medicine (EM) residency graduates are trained to perform Emergency Medicine bedside ultrasound (EMBU). However, the degree to which they use this skill in their practice after graduation is unknown. Objectives: We sought to test the amount and type of usage of EMBU among recent residency graduates, and how usage and barriers vary among various types of EM practice settings. Methods: Graduates from 14 EM residency programs in 2003-2005 were surveyed on their current practice setting and use of EMBU. Results: There were 252 (73%) graduates who completed the survey. Of the 73% of respondents reporting access to EMBU, 98% had used it within the past 3 months. Access to EMBU was higher in academic (97%) vs. community teaching (79%) vs. community non-teaching settings (62%) (p < 0.001), and in Emergency Departments (EDs) where yearly census exceeded 60,000 visits (87% vs. 65%, p < 0.001). Physicians in academic settings reported "high use" of EMBU more frequently than those in community settings for most modalities. FAST (focused assessment by sonography in trauma) was the most common high-use application and the most useful in practice. The greatest impediment to EMBU use was "not enough time" (61%). Conclusions: Ultrasound usage among recent EM residency graduates is significantly higher in teaching than in community settings and in highvolume EDs. Its use is more widespread than in previous reports in all types of practice. There is a wide range of utilization of ultrasound in the various applications in emergency practice, with the evaluation of trauma being the most common.

Anaesthesia Critical Care &amp; Pain Medicine, 2018

Objective: Ensuring the availability of ultrasound devices is the initial step in implementing clinical ultrasound (CUS) in emergency services. In France in 2011, 52% of emergency departments (EDs) and only 9% of mobile intensive care stations (MICS) were equipped with ultrasound devices. The main goal of this study was to determine the movement of these rates since 2011. Methods: We conducted a cross-sectional, descriptive, multi-centre study in the form of a questionnaire. To estimate the numbers of EDs and MICS equipped with at least one ultrasound system with a confidence level of 95% and margin of error of 5%, 170 responding EDs and 145 MICS were required. Each service was solicited three times by secure online questionnaire and then by phone. Results: 328 (84%) services responded to the questionnaire: 179 (86%) EDs and 149 (82%) MICS. At least one ultrasound machine was available in 127 (71%, 95% CI [64; 78]) EDs vs 52% in 2011 (p < 0.01). 42 (28%, 95% CI [21; 35]) MICS were equipped vs 9% in 2011 (p < 0.01). In 97 (76%) EDs and 24 (55%) MICS, less than a half of physicians were trained. CUS was used at least three times a day in 52 (41%) EDs and in 8 (19%) MICS. Conclusion: Our study demonstrates improved access to ultrasound devices in French EDs and MICS. Almost three-quarters of EDs and nearly one-third of MICS are now equipped with at least one ultrasound device. However, the rate of physicians trained per service remains insufficient.

Journal of the American College of Radiology, 2004

Purpose: To ascertain changes in the utilization rates of diagnostic ultrasound among radiologists, cardiologists, and other physicians in recent years. Methods and Materials: The nationwide Medicare Part B databases for 1993 and 2001 were searched in all ultrasound Current Procedural Terminology 4 codes, except for ophthalmic ultrasound and supervision and interpretation codes. Ultrasound examinations were categorized as general, vascular, breast, obstetric (very low in the Medicare population), and echocardiography. Using the Medicare physician specialty codes, utilization rates per thousand Medicare beneficiaries per year were calculated for radiologists, cardiologists, and other physicians for all codes in the five aforementioned categories. Results: Radiologists performed 24% of all ultrasound examinations in 2001. The overall utilization rate of ultrasound examinations among radiologists increased from 132.9 per thousand Medicare beneficiaries in 1993 to 166.3 in 2001, a 25% increase. Among cardiologists, the rate increased from 190.3 in 1993 to 356.1 in 2001, an 87% increase. The vast bulk of these examinations were echocardiograms, but cardiologists also had some involvement in vascular ultrasound. Among other physicians, the rate increased from 116.9 in 1993 to 167.0 in 2001, a 43% increase. The areas of greatest involvement by these other physicians were echocardiography, vascular ultrasound, and general ultrasound. Of the five ultrasound categories, echocardiography had by far the highest volume. Conclusion: Nonradiologist physicians utilize ultrasound at much higher rates than radiologists, primarily reflecting the influence of echocardiography. Between 1993 and 2001, the ultrasound utilization rate grew over 3 times as rapidly among cardiologists as among radiologists; the rate among other physicians grew almost twice as rapidly as it did among radiologists. This raises the concern that self-referral may be leading to higher utilization and costs.