If ultrasound is the future, why is there still so much practice variation between emergency departments?
Bedside ultrasound (US) has been called “the stethoscope of the 21st century”. Although its availability in emergency departments (EDs) throughout the United States has grown steadily over the past few decades, it’s use in community EDs is still far from universal. In 2016, most hospitals with an emergency medicine residency will have one, if not multiple dedicated bedside US machines, and most large urban EDs will also have a dedicated machine. However, smaller EDs, rural EDs and community EDs are less likely to have an ultrasound machine for bedside use by emergency physicians and mid-levels, and even in departments that do, it may sit in the corner gathering dust. Perhaps this is because many providers don’t have the time or the skill required to take advantage of all that bedside point of care ultrasound (POCUS) has to offer. Why is this? What percent of your EM colleagues have access to POCUS? Of those who do, how are they using it to help their patients?
A 2004 survey by Moore et al. of ED directors from 1130 of the nation’s 5264 EDs showed the ultrasonography was available in the ED for use by emergency physicians at all times for only 19% of respondents. Fifteen percent had ultrasonography at “certain times” while 66% said “not at all”. ED directors reported being requested to limit orders for formal ultrasonography performed by radiology during “off hours” in 41% of EDs. In the Moore study emergency physician performed ultrasonography was most commonly used in the following applications: Focused Assessment with Sonography for Trauma (FAST) (85%), code blue situations (72%), and evaluation for pericardial effusion (67%). Of physician groups performing POCUS, only 16% were requesting reimbursement from payers.
A 2009 survey of bedside ultrasound use by emergency physicians in California by Stein et al contacted 293 EDs and found that 34% reported use of bedside ultrasound. Of these EDs, an average of 48% of physicians at each site were credentialed, and 70% said they used the American College of Emergency Physicians (ACEP) criteria for credentialing (even though only 33% had an ultrasound QA program as recommended by the ACEP guideline). 68% of academic departments used bedside ultrasound compared with 29% of community EDs.
This month we would like to explore emergency physician use of Point Of Care UltraSound (POCUS) in the United States by surveying our readers. Please make your voice heard by completing the 10-question survey below. We would love to also hear your comments so if you have the time, please leave them.
Preliminary survey results will be posted next month, followed by a follow up email trying to get a 100% response rate from our subscribers. Final results will be submitted for publication in a peer reviewed EM journal.