Ultrasound help

[spyderdoc]

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We are in the process of trying to convince our reluctant radiologists to "support" our purchase and use of an ED U/S. We are having a meeting on Wednesday. Of coure their reluctance does not stem from anything other than the potential revenue loss. Any helpful hints on how I can help persuade the rads on this?

 

[Pathmonster]

We are in the process of trying to convince our reluctant radiologists to "support" our purchase and use of an ED U/S. We are having a meeting on Wednesday. Of coure their reluctance does not stem from anything other than the potential revenue loss. Any helpful hints on how I can help persuade the rads on this?

That seems like a valid concern. Plus there could be argument about quality of care.

 

[margaritaboy]

That seems like a valid concern. Plus there could be argument about quality of care.

Remember, us emergency docs are not trying to set up an ultrasound clinic and measure the widths of gall bladders and the echogenicity of livers.

We ask a focused clinical question like: Is there free fluid in the abdomen in this hypotensive trauma patient?

Or: Is this the internal jugular vein or carotid artery that I am about the insert this central line into for fluid recusitation?

Or: Is there any cardiac motion in this medical code in whom CPR has been done on for 15 minutes?

These are not the patients that we are going to order formal ultrasounds on anyway. Thus, I doubt the loss of revenue for SpyderDocs Rads department. Also, I'm not sure how quality could be any worse if ultrasound was available in the above situations.

 

[Chartres]

Not to mention that the use of US to guide procedures that are being performed on a routine basis anyway has been shown to improve quality of care

 

[peksi]

PM me [email protected].

Paul

 

[spyderdoc]

PM me [email protected].

Paul

Thanks Paul. I sent you an email...

Mark

 

[Seaglass]

Plus the argument has been "we will always be ordering a formal follow up scan so there is no loss in revenue." Or you could just argue that it is now standard of care, which is almost true. As for quality of care, if you are appropriately trained and credentialed then the quality should certainly be adequate.

 

[JackBauERfan]

We are in the process of trying to convince our reluctant radiologists to "support" our purchase and use of an ED U/S. We are having a meeting on Wednesday. Of coure their reluctance does not stem from anything other than the potential revenue loss. Any helpful hints on how I can help persuade the rads on this?

Ultrasound rocks and I vote to bring it to the ED! If the pathologists can't handle us, what makes you think radiologists can bully us around. Ain't happening is all I'm saying.

 

[peksi]

The data on the effect of EUS on radiology ordered ultrasounds is clear, there is a shortterm bump, then in the long term a significant drop, but often there is inreases in other "hard imaging" such as CT and MRI. The reality here is I as an EP treat patients, Ultrasound assists in what the ultimate intent of my job is "to identify and treat life and limb threatening conditions" and where I'm at I and my group need to do that 150,000 time. EUS IS a critical component of that about 7,000 times per year!

ABSTRACT

Short- and Long-term Effects of Emergency Medicine Sonography on Formal Sonography Use
A Decade of Experience

Jeanne L. Jacoby, MD, Dave Kasarda, MD, Scott Melanson, MD, John Patterson, MD and Michael Heller, MD
Emergency Medicine Residency Program, St Luke’s Hospital, Bethlehem, Pennsylvania USA.


Objectives. It has been reported that use of formal sonographic studies by departments of radiology initially increases after inception of an emergency medicine (EM) sonography training program, but there are no data on whether this trend continues as the training program matures. The purpose of this study was to evaluate the effect of an ongoing EM sonography program on formal sonography use after more than a decade of experience. Methods. This retrospective, computer-assisted review compared emergency department (ED) abdominal sonographic studies ordered in the 3 years before inception of an EM sonography program (1992–1994) with those ordered in the 8 years after its inception (1995–2002). To determine the relative change, all abdominal sonograms ordered by ED physicians were compared with equivalent outpatient formal sonograms by all other physicians in the hospital. The study site is a community teaching hospital with a current ED census of 50,000. Results. In the initial 4 years (1995–1998), the number of formal studies increased significantly in both absolute numbers (annual mean, 95 versus 162; P < .002) and as a percentage of all outpatient sonograms ordered at the institution (5.1% versus 8.5%; P < .0001). However, in the following 4 years (1999–2002), the absolute number of formal studies remained constant but decreased when adjusted for an increased ED census. Emergency department–ordered formal studies also decreased as a percentage of all sonograms ordered (5.1% versus 4.1%; P = .002). Conclusions. Emergency department use of formal sonography services increases with the introduction of ED sonography but decreases markedly as the program matures.

 

[roja]

Plus the argument has been "we will always be ordering a formal follow up scan so there is no loss in revenue." Or you could just argue that it is now standard of care, which is almost true. As for quality of care, if you are appropriately trained and credentialed then the quality should certainly be adequate.

Most U/S directors I have spoken with would argue against this... Most, in the long term DO want to end up billing for thier ultrasounds. This arguement ultimately weakens the perception of your own abilities. And they ARE formal ultrasounds. They are just FOCUSED FORMAL ultrasounds. Looking for one or a few particular things.

However, using the arguement: You dont' want to come in at X hour of the night/morning to look for a GALLSTONE do you? is often effective.