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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
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
ama resolution 802 1999
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”
benefits of an eus program
Benefits of an EUS Program
  • Improved patient care
  • Saves time
  • Saves money
  • Recruiting
  • Life Saving
  • Improved Patient Satisfaction
improved patient care
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
saves time
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
saves money
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
recruiting
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
emergency ultrasound1
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.
indications
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?
components of an ed ultrasound program
Components of an ED Ultrasound Program
  • Equipment
  • Training / Credentialing
  • Quality assurance
  • Emergency ultrasound program coordinator
requirements for ed machine
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

purchase goals
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
training and credentialing
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
training practice based pathway
TrainingPractice Based Pathway
  • Overview
    • Initial Training in a 16 - 24 hour Introductory Course
    • Experiential and Competency Phase
    • Credentialed in Emergency Ultrasound
    • Continuing Medical Education
training practice based pathway1
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
training
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
training practice based pathway2
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
slide22

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.
quality assurance
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
quality assurance1
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.
financial
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

financial1
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

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