A Survey of the Emergency Ultrasound Administrative Systems Within North American Emergency Ultrasound Fellowship Programs

Abstract

To determine the existing mechanisms being employed for quality assurance, documentation, image storage, credentialing, and reimbursement of emergency ultrasound (US) in North American emergency ultrasound fellowship programs. We prospectively surveyed North American emergency medicine (EM) ultrasound fellowship program directors, as identified on www.eusfellowships.com on March 11, 2011, via a previously piloted Web-based survey instrument containing 37 items spanning five topics including: 1) credentialing and training, 2) documentation and storage, 3) quality assurance (QA) and image review, 4) billing, and 5) overall satisfaction. The survey was developed initially by and later finalized by the investigation team including a master statistician, after incorporating feedback from pilot testing to EM ultrasound directors without fellowship programs, research experts, and survey experts. All surveys were distributed using the ACEP- SNAP survey software (Snap Surveys Ltd., Portsmouth, NH) via email to ultrasound fellowship directors, and once received, all survey responses were de-identified to ensure unbiased handling of the data. Descriptive statistical analyses are primarily used to display the data. Over a one-year period, 62% of the directors responded (n=47) and one program declined to participate out of 75 eligible fellowship programs. The programs reported a median number of 5000 (IQR: 3000- 8200) point-of-care US scans performed at their department annually. Respondents reported having an average of 4.3 (SD: 3.5) ultrasound faculty, 63% of whom completed an US fellowship. Sixteen out of 46 programs (34.8%) reported having using a commercial US workflow program with 9/16 (56%) of them choosing Q-Path (Telexy Health Care, Everett, WA). 57% of respondents reported having a formalized credentialing process with the majority of these programs (91%) incorporating ACEP credentialing criteria (www.acep.org). Regarding QA, 94% of the programs reported having a QA and image review process in place; these range in frequency from once a week (71%) to a daily-based process (4%). Only 45% of programs review 100% of the images during these QA sessions. In order to provide feedback to front-line providers, 63% of the directors reported using electronic email and only 10% are using Web-based system for this purpose. On average 45% of the programs reported billing for their scans and only a quarter of the programs reported submitting more than 51% of their performed scans for billing. Fourteen programs reported their estimated annual revenue, as a median of $375,000 (IQR: 46,250-1000,000), from the point-of-care ultrasound scans performed. This study describes the current state of administrative processes among North American EM ultrasound fellowship programs. This information provides useful demographics on the leading programs in emergency US for developing and expanding programs to potentially emulate. Furthermore, this data provides a foundation for further study of best practices and models in emergency ultrasound administration.