A framework for implementation, education, research and clinical use of ultrasound in emergency departments by the Danish Society for Emergency Medicine

Laursen, Christian B.; Nielsen, Klaus; Riishede, Minna; Tiwald, Gerhard; Møllekær, Anders; Aagaard, Rasmus; Posth, Stefan; Weile, Jesper

doi:10.1186/1757-7241-22-25

Cited by 18 publications

(18 citation statements)

References 5 publications

(7 reference statements)

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“…Recommendations have been published on how to store images and document examinations [25], but these are not followed. Our findings, which show a surprisingly low frequency of storage and documentation, call for attention to the problem in the local guidelines.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography in trauma: a nation-wide cross-sectional investigation

et al. 2017

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BackgroundThe Focused Assessment with Sonography in Trauma (FAST) protocol is considered beneficial in emergent evaluation of trauma patients with blunt or penetrating injury and has become integrated into the Advanced Trauma Life Support (ATLS) protocol. No guidelines exist as to the use of ultrasonography in trauma in Denmark. We aimed to determine the current use of ultrasonography for assessing trauma patients in Denmark.MethodsWe conducted a nation-wide cross-sectional investigation of ultrasonography usage in trauma care. The first phase consisted of an Internet-based investigation of existing guidelines, and the second phase was a series of structured interviews of orthopedic surgeons, anesthesiologists, and radiologists on call in all hospitals receiving traumatized patients in Denmark.ResultsGuidelines were obtained from all 22 hospitals receiving traumatized patients in Denmark. Twenty-one (95.5%) of the guidelines included and recommended FAST as part of trauma assessment. The recommended person to perform the examination was the radiologist in n = 11 (50.0%), the surgeon in n = 6 (27.3%), the anesthesiologist in n = 1 (4.5%), and unspecified in n = 3 (13.6%) facilities. FAST indications varied between circulatory instability n = 8 (36.4%), team leader’s discretion n = 6 (27.3%), abdominal trauma n = 3 (13.6%), and not specified n = 6 (27.3%). Telephone interviews revealed that exams were always n = 8 (36.4%) or often n = 4 (18.2%) registered in the patients’ charts. The remaining n = 10 (45.5%) facilities either never registered n = 2 (9.1%), it was not possible to register n = 1 (4.5%), or unknown by the trauma leaders n = 7 (31.8%). Images were often stored in n = 1 (4.5%), never stored in n = 10 (45.5%), not possible to store in n = 2 (9.1%), and unknown in n = 9 (40.9%) facilities.ConclusionUltrasonography was used in a non-uniform fashion by multiple specialties in Danish trauma facilities. Very few images from FAST examinations were stored and documentation was scanty. National guidelines on application and documentation of ultrasonography in trauma are called for.Electronic supplementary materialThe online version of this article (doi:10.1186/s13089-017-0071-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Ultrasonography in trauma: a nation-wide cross-sectional investigation

et al. 2017

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“…In the United States the development of emergency medical ultrasound seems to really have taken off after ACEP published its Emergency Ultrasound Guidelines for the first time in 2001 and again in 2009 [ 1 ]. In Denmark, the Danish Society for Emergency Medicine recently published an article proposing a framework for the implementation, education, research and clinical use of ultrasound in Danish EDs and this might, in the future, contribute to a more widespread use of the tool [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Physicians using ultrasound in Danish emergency departments are mostly summoned specialists

Nielsen

Lauridsen

Laursen

et al. 2015

Scand J Trauma Resusc Emerg Med

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BackgroundEmergency ultrasound is a relatively new diagnostic discipline. It is used as an extension of the clinical examination and is ideal in the setting of acute illness. The objective of this study was to investigate how many Emergency Departments (EDs) in Denmark have implemented emergency ultrasound. We also wanted to give an idea of how many and which physicians have adopted ultrasound as a diagnostic tool so far.MethodsThe study was a cross-sectional, descriptive, multicenter survey that included all physician staffed EDs in Denmark. An Internet based questionnaire was distributed by e-mail to all heads of department. Those departments who responded that ultrasound was available in their department were included in the second part of the study where all physicians working in the ED were contacted and asked to complete a second questionnaire.ResultsAll 28 eligible EDs participated in the first part of the study (Response rate: 100 %). 25 EDs (89 %, 95 % CI: 85-93) had ultrasound equipment available. Questionnaires were distributed to 1,872 physicians in these departments and 561 responded (Response rate: 30 %, 95 % CI: 28-32). Overall 257 (46 %, 95 % CI: 42-50) were users of emergency ultrasound and 304 were non-users (54 %, 95 % CI: 50-58). The largest group with 146 respondents (25 %, 95 % CI: 21-29) were anaesthetists with merely consult duty in the ED. When looking exclusively on physicians with on-call duty in the ED, thus excluding anaesthetists, only 146 (35 %, 95 % CI: 30-40) were users of ultrasound while 269 (65 %, 95 % CI: 60-70) were non-users. There was a considerable difference regarding age, level of training, and medical specialty between users and non-users. Users were mainly anaesthetists and attending physicians from other departments. The majority of non-users were young physicians with on call duty in the ED.ConclusionsWe have found that although almost all Danish EDs have ultrasound equipment available, few physicians working in the ED seem to have adopted the tool. Emergency Ultrasound is mainly performed by specialists who are summoned to the ED in case of severe acute illness and not by those physicians who comprise the backbone of the ED around the clock.

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“…Prior to its commencement, this study was reviewed and assigned exempt status by the Mt. Auburn Hospital Institutional Review Board (45 CFR 46.101[b] [2]).…”

Section: Study Design Setting and Populationmentioning

confidence: 99%

Point‐of‐Care Ultrasonography (POCUS) in a Community Emergency Department: An Analysis of Decision Making and Cost Savings Associated With POCUS

Schaik

Murphy

2018

J of Ultrasound Medicine

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Objectives Point‐of‐care ultrasonography (POCUS) is an increasingly integral part of emergency medicine. This study investigated community emergency department physicians’ choices regarding ultrasonography as a branch point in clinical decision making. Methods During shifts covering all days of the week and all time‐spans over a 3‐month period, emergency department physicians were interviewed whenever POCUS was used. Questions focused on the role of POCUS in clinical management and on tests avoided because of ultrasonography use. Cost savings attributable to POCUS were calculated using Center for Medicare and Medicaid Services and FairHealth data. Anonymization of data precluded follow‐up testing to account for misdiagnosis. Results On average, POCUS use eliminated $1134.31 of additional testing for privately insured patients, $2826.31 for out‐of‐network or uninsured patients, and $181.63 for Center for Medicare and Medicaid Services patients. Differences were significant when the total cost of eliminated additional testing was compared to a baseline of no savings (p < .001). Aggregate cost savings remained significant when analyses were broadened to include POCUS encounters that did not yield changes in management (p < .001). Conclusions When physicians’ clinical expertise suggests that POCUS may be indicated, its use results in significant cost savings, even in encounters in which management is not directly impacted. POCUS, when incorporated earlier and more frequently into community hospital emergency medicine diagnostic protocols, can lower direct and indirect costs associated with diagnostic workups. Community emergency departments, in particular, would benefit from additional investigation informing specific guidelines for the integration of POCUS into clinical management and the role that this has in cost savings.

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A framework for implementation, education, research and clinical use of ultrasound in emergency departments by the Danish Society for Emergency Medicine

Cited by 18 publications

References 5 publications

Ultrasonography in trauma: a nation-wide cross-sectional investigation

Ultrasonography in trauma: a nation-wide cross-sectional investigation

Physicians using ultrasound in Danish emergency departments are mostly summoned specialists

Point‐of‐Care Ultrasonography (POCUS) in a Community Emergency Department: An Analysis of Decision Making and Cost Savings Associated With POCUS

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