Emergency Ultrasound Proposal

1
Emergency Ultrasound Proposal
2
Emergency Ultrasound

• In common use since early 1990s
• First curriculum was published in 1994
• Supported by professional societies
• American Board of Emergency Medicine
• American College of Emergency Physicians
• Society of Academic Emergency Medicine
• Accreditation Council for Graduate Medical
  Education
• American Medical Association

3
AMA Resolution 802 (1999)

• ultrasound imaging is within the scope of
  practice of appropriately trained physician
  specialists
• each hospital medical staff should review and
  approve criteria for granting ultrasound
  privileges in accordance with recommended
  training and education standards developed by
  each physician's respective specialty society

4
Benefits of an EUS Program

• Improved patient care
• Saves time
• Saves money
• Recruiting

5
Improved patient care

• Better door to diagnosis time
• Better door to treatment time
• Focused Ultrasound is performed in concurrently
  with management of the patient
• Improved patient satisfaction

6
Saves Time

• Ultrasounds often completed in minutes
• Not hours
• Decreased throughput time for ED patients
• Better door to diagnosis time
• Better door to treatment time
• Better ED bed efficiency

7
Saves Money

• Alternative to more complex, expensive studies
• Decreased use of limited resources for non-funded
  patients
• Avoid ED crowding caused by waiting for
  completion of ultrasound study

8
Recruiting

• In 2003 the ACGME required all EM residencies to
  provide Emergency Ultrasound training
• This has become a litmus test for whether an EM
  group is current
• Some questions on standard of care
• Continued board certification
• Core Content of Emergency Medicine
• EM LLSA exam
• EM board certification exam

9
Emergency Ultrasound

• Limited , focused exams that ask specific
  questions
• Contrasted with formal ultrasound which is
  intended as a full survey of the organ / system
  in question.

10
Indications

• Is there blood in the abdomen?
• Is there a pericardial effusion?
• Is there an abdominal aortic aneurysm?
• Is there evidence of an IUP?
• Is there EMD?
• Is there evidence of Cholecystitis?
• Is there evidence of obstructive uropathy?

11
Is there blood in the abdomen?
Normal
Abnormal
12
Is there a pericardial effusion?
Normal
Abnormal
13
Components of an ED Ultrasound Program

• Equipment
• Training / Credentialing
• Quality assurance
• Emergency ultrasound program coordinator

14
Equipment
15
Requirements for ED Machine
Ease of Use
Image Quality
Image Report Management
Best Machine For ED Use
Special Features
Cost
Durability
Portability
Service Upgradeability Warranty
16
Purchase Goals

• Best Image Quality for Lowest Price
• Ease of Use for all users
• Image and Report Management/Wireless
• Initial Cost
• Portability
• Durability
• Warranty and On Going Cost
• Service and Reliability
• Presentation of Images to Patient

17
Training / Credentialing

• 2 step credentialing process
• Provisional
• A. Education- MD or DO AND
• B. Training- Board Certified or eligible in
  Emergency Medicine OR
  completion of residency in Emergency Medicine
  AND
• C. Experience - 25 supervised examinations or
  25 cases with acceptable
  verification as determined by the emergency
  ultrasound director AND
• D. 16 hours of a formal education that conforms
  to the ACEP guidelines

18
Training

• Two options
• Each physician attend a formal course
• Expensive 800 x 26
• import a course here
• Use our own US machines
• Less expensive
• OKd by Medical Education
• Commitment by national EUS instructor

19
Training / Credentialing

• Full
• A. MD or DO AND
• B. Board Certified or eligible in Emergency
  Medicine AND
• C. Residency training in EUS with acceptable
  verification OR
• D. Performance of 150 total exams with
  competence documented by ongoing
  CQI review.
• E. Letter of reference by the Emergency
  Ultrasound Director.

20
Quality Assurance

• Performed by EUS director or other credentialed
  EMPs
• Purpose
• as a tool for education and feedback for
  physicians completing the credentialing process
• to monitor ongoing performance of physicians that
  have completed the credentialing process

21
Quality Assurance

• The ultrasounds will be reviewed on three
  criteria
• Was the study indicated by the patients
  presentation?
• Was the study technically adequate?
• Was the interpretation correct?
• The findings of the review process will drive the
  ongoing medical education in the form of
• Journal Club
• Formal didactics
• Practice sessions.

22
Financial
Estimated Initial Expenditure Ultrasound
equipment (2) 80,000 (range 65k to
120k) Initial Training Course 5,000 (range up
to 21k 26 EPs x 800) Quality
Assurance 19,500 (range up to 40k if outside
QA) Ongoing Expenditure Paper, cleaner,
etc. 1000/year Insurance/maintenance 1000/yea
r Estimated Total Expenditure 104,500 plus
1000-2000 annual
23
Financial
Estimated Income Trauma APC 0266 and 0697
179.26 Estimated patients/year
480 Total 86,044 Approx 30
collection 25,813 Pregnancy/IUP APC
0266 92.74 Estimated patients/year
1095 101550 Approx 30 collection
30,465 Estimated Income, Trauma and IUP
only 56,278/year
24
Summary

• Significant benefit of emergency US program
• Minimal financial risk
• Supported by
• National societies
• Trauma
• Critical Care Committee
• Emergency Physicians