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Emergency Ultrasound Proposal

Emergency Ultrasound Proposal. Emergency Ultrasound. In common use since early 1990’s 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

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Emergency Ultrasound Proposal

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  1. Emergency Ultrasound Proposal

  2. Emergency Ultrasound • In common use since early 1990’s • 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 • Emergency Ultrasound Guidelines updated 2008

  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 • Life Saving • Improved Patient Satisfaction

  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 • ACGME • In 2003 required all EM residencies to provide Emergency Ultrasound training • Emergency Ultrasound is defined as a “skill integral to the practice of Emergency Medicine” as defined in the “2007 Model of Clinical Practice of Emergency Medicine “ • This has become a litmus test for whether an EM group is current • Continued board certification • Core Content of Emergency Medicine • EM LLSA exam • EM board certification exam

  9. Emergency Ultrasound • Is a Limited, goal directed focused ultrasound exam that answers brief and important clinical questions in an organ system, or for a clinical symptom or sign involving multiple organ systems • 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 and Credentialing • Prerequisites • A. Education- MD or DO;AND • B. Training- Board Certified or eligible in Emergency Medicine; OR completion of residency in Emergency Medicine; AND • Credentialing process • Residency training in Emergency Ultrasound with acceptable verification • Practice Based Pathway • Provisional • Active

  18. TrainingPractice Based Pathway • Overview • Initial Training in a 16 - 24 hour Introductory Course • Experiential and Competency Phase • Credentialed in Emergency Ultrasound • Continuing Medical Education

  19. TrainingPractice Based Pathway • Initial Training in a 16 - 24 hour Introductory Course • Covers Core Applications • Practical hands-on Sessions Course • Models are in the Emergency Ultrasound Guidelines and the ACEP Web Site • Shorter 4 - 8 hour course • Focus on Core application or Skill • Didactic and Hands on

  20. Training • Two options • Each physician attend a formal course • Expensive $800 - $2000 x # in group = _______ • “Import” a course here • Use our own US machines • Less expensive • OK’d by Medical Education • Commitment by national EUS instructor

  21. TrainingPractice Based Pathway • Experiential and Competency Phase • Develops the Psychomotor and cognitive Components • For General Emergency Competency • 150 - 250 Cases in a case controlled manner • 25 - 50 in each of the Core Application • Procedural • 10 Cases in a case controlled manner • Completion of a Module with a high Quality Training Phantom

  22. Credentialing • Active (Full) • MD or DO; AND • Board Certified or eligible in Emergency Medicine AND • Residency training in EUS with acceptable verification; OR • General • Performance of 150 -250 total exams with competence documented Case controlled review • Procedural • Performance of 10 total exams with competence documented by case controlled review. • Letter of reference by the Emergency Ultrasound Director.

  23. Quality Assurance • Performed by EUS director or other credentialed EMP’s • 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

  24. Quality Assurance • The ultrasounds will be reviewed on three criteria: • Was the study indicated by the patient’s 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.

  25. Financial Estimated Initial Expenditure Ultrasound equipment (2) $80,000 (range 65k to 120k) Initial Training Course $5,000 (range up to 21k: 26 EP’s x $800) Quality Assurance $19,500 (range up to 40k if outside QA) Ongoing Expenditure Paper, cleaner, etc. $1000/year Insurance/maintenance $1000/year Estimated Total Expenditure $104,500 plus $1000-2000 annual

  26. 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

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

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