Access to and Use of Point-of-Care Ultrasound in the Emergency Department.

Jason Sanders,Ashley Sullivan,Carlos Camargo,Ali Raja,Vicki Noble

doi:10.5811/westjem.2015.7.27216

Abstract

IntroductionGrowing evidence supports emergency physician (EP)-performed point-of-care ultrasound (PoC US). However, there is a utilization gap between academic emergency departments (ED) and other emergency settings. We elucidated barriers to PoC US use in a multistate sample of predominantly non-academic EDs to inform future strategies to increase PoC US utilization, particularly in non-academic centers.MethodsIn 2010, we surveyed ED directors in five states (Arkansas, Hawaii, Minnesota, Vermont, and Wyoming; n=242 EDs) about general ED characteristics. In four states we determined barriers to PoC US use, proportion of EPs using PoC US, use privileges, and whether EPs can bill for PoC US.ResultsResponse rates were >80% in each state. Overall, 47% of EDs reported PoC US availability. Availability varied by state, from 34% of EDs in Arkansas to 85% in Vermont. Availability was associated with higher ED visit volume, and percent of EPs who were board certified/board eligible in emergency medicine. The greatest barriers to use were limited training (70%), expense (39%), and limited need (perceived or real) (32%). When PoC US was used by EPs, 50% used it daily, 44% had privileges not requiring radiology confirmation, and 34% could bill separately for PoC US. Only 12% of EPs used it ≥80% of the time when placing central venous lines.ConclusionOnly 47% of EDs in our five-state sample of predominantly non-academic EDs had PoC US immediately available. When available, the greatest barriers to use were limited training, expense, and limited need. Recent educational and technical advancements may help overcome these barriers.

Highlights

Growing evidence supports emergency physician (EP)-performed point-of-care ultrasound (PoC US)
Availability was associated with higher emergency departments (ED) visit volume, and percent of EPs who were board certified/board eligible in emergency medicine
When PoC US was used by EPs, 50% used it daily, 44% had privileges not requiring radiology confirmation, and 34% could bill separately for PoC US

Summary

Introduction

Growing evidence supports emergency physician (EP)-performed point-of-care ultrasound (PoC US). As pressures on emergency physicians (EPs) grow to see ever more patients quickly and cost effectively, there has been a surge in literature demonstrating that point-of-care ultrasound (PoC US) can decrease cost,[1] reduce need for additional diagnostic testing,[2] improve patient throughput[3] and patient satisfaction,[4] and may reduce need for imaging with ionizing radiation.[5] PoC US image acquisition and interpretation is a core competency for emergency medicine residency training Despite this growing evidence base and improved training efforts, previous surveys of PoC US have demonstrated a utilization gap, most notably between rural and urban emergency departments (ED), low and high volume EDs, and EDs with a lower proportions of emergency medicine board certified/board eligible (EM BC/BE) EPs vs EDs with more EM BC/BE EPs.[6] These distinctions are important because most individuals do not receive emergency care at Volume XVI, no. Building on previous work surveying PoC US at diverse practice sites across the United States,[6] we performed a more detailed survey to study PoC US utilization and determine specific barriers to utilization

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Results

Discussion

Conclusion