Description of the Use of Incentives and Penalties for Point-of-Care Ultrasound Documentation Compliance in an Academic Emergency Department

Melton, Myles F.; Rupp, Jordan; Blatt, Marc I; Boyd, Jeremy S.; Barrett, Tyler W.; Swarm, Matthew; Ward, Michael J.

doi:10.7759/cureus.16199

Cited by 5 publications

(9 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We also believe the department leadership's willingness to offer a financial incentive made a profound statement as to the importance of achieving this training as well as recognizing that practicing physicians should have some compensation as to the amount of time needed to achieve privileging. The positive impact of financial incentive on POCUS training and documentation is consistent with prior reports 27,28 . Similar to our model, Budhram et al 27 built in a financial incentive into their POCUS training and privileging program from the beginning.…”

Section: Discussionsupporting

confidence: 88%

“…While they did not directly measure the effect that this financial incentive played, they theorized that the incentive as well as deadlines were a key part of successfully privileging a small cohort of EPs. Similarly, Melton et al 28 found that providing both positive and negative financial incentives resulted in improved POCUS documentation among EPs who had already achieved POCUS privileges, ultimately improving the rate and number of POCUS studies that were completed for clinical care. While a financial incentive seems to be a reliable motivator for POCUS education and credentialing, there are examples of successful educational programs without a financial component.…”

Section: Discussionmentioning

confidence: 97%

Section: Ta B L E 1 Emergency Physician Demographicsmentioning

confidence: 99%

“…The positive impact of financial incentive on POCUS training and documentation is consistent with prior reports. 27,28 Similar to our model, Budhram et al 27 built in a financial incentive into their POCUS training and privileging program from the beginning. While they did not directly measure the effect that this financial incentive played, they theorized that the incentive as well as deadlines were a key part of successfully privileging a small cohort of EPs.…”

Section: Ta B L E 1 Emergency Physician Demographicsmentioning

confidence: 99%

See 3 more Smart Citations

Success of implementation of a systemwide point‐of‐care ultrasound privileging program for emergency medicine faculty

Kennedy

Ferre

Rood

et al. 2022

AEM Education and Training

View full text Add to dashboard Cite

Objectives Point‐of‐care ultrasound (POCUS) is widely used in the emergency department (ED). Not all practicing emergency physicians received POCUS training during residency, leaving a training gap that is reflected in POCUS privileging. The purpose of this study was to evaluate the success of meeting privileging criteria as well as associated factors, following implementation of a basic POCUS training and privileging program within a large emergency medicine department. Methods We implemented a POCUS training and privileging program, based on national guidelines, for faculty physicians who worked at one of the following EDs staffed by the same emergency medicine department: a pediatric tertiary site, two tertiary academic sites, and seven community sites. POCUS examinations included aorta, cardiac, first‐trimester obstetrics (OB), and extended focused assessment with sonography in trauma. Pediatric emergency medicine faculty were taught soft tissue and thoracic US instead of aorta and OB. Completion of the program required 16 h of didactics, ≥25 quality‐assured US examinations by examination type, and passing a series of knowledge‐based examinations. Descriptive statistics were calculated. Associations between physician characteristics and successfully becoming privileged in POCUS were modeled using Firth's logistic regression. Results A total of 176 faculty physicians were eligible. A total of 145 (82.4%) achieved basic POCUS privileging during the study period. Different pathways were used including 86 (48.9%) practice‐based, nine (5.1%) fellowship‐based, and 82 (46.9%) residency‐based. POCUS privileging was lower for those working in a community versus academic setting (odds ratio 0.3, 95% confidence interval 0.1–0.9). A greater number of scans completed prior to the privileging program was associated with greater success. Conclusions Implementation of a POCUS training and privileging program can be successful in a large emergency medicine department that staffs hospitals in a large‐scale health care system composed of both academic and community sites. Faculty physicians with at least some prior exposure to POCUS were more successful.

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 97%

Section: Ta B L E 1 Emergency Physician Demographicsmentioning

confidence: 99%

Section: Ta B L E 1 Emergency Physician Demographicsmentioning

confidence: 99%

See 2 more Smart Citations

Success of implementation of a systemwide point‐of‐care ultrasound privileging program for emergency medicine faculty

Kennedy

Ferre

Rood

et al. 2022

AEM Education and Training

View full text Add to dashboard Cite

show abstract

“…[1][2][3] Despite the necessity and ubiquity of ED POCUS, many centers have described a lack of consistency and accuracy in documentation. [4][5][6] Commonly cited reasons for poor POCUS documentation often include lack of time on shift and the need for manual patient data entry into the ultrasound machines. Physicians report that ultrasound documentation processes are too time intensive and require logging onto multiple electronic health records (EHRs) and picture archive and communications systems (PACS).…”

Section: Introductionmentioning

confidence: 99%

Implementation of an automated, user‐centered point‐of‐care ultrasound workflow improves documentation and billing

Thompson

Schoenfeld²,

Westafer³

et al. 2023

Academic Emergency Medicine

View full text Add to dashboard Cite

Background Point‐of‐care ultrasound (POCUS) is a central component of emergency medical care. However, clinicians often fail to adequately document their examinations, causing problems for downstream clinicians and quality assurance processes as well as loss of revenue. The objective of this study was to evaluate the impact of a user‐centered POCUS documentation workflow system for examination ordering, documentation, selective archival, and billing on POCUS documentation in a large academic emergency department (ED). Methods In this quasi‐experimental study, we examined POCUS documentation 22 months before and 12 months after implementation of a user‐centered, automated ultrasound workflow (October 2018–July 2021). The workflow allows for electronic health record (EHR) order entry to populate a virtual ultrasound worklist, automatic demographic information retrieval to ultrasound machines, selective image storage to a hospital picture archive and communications system and/or POCUS archive Ultralinq, generation of an EHR report, and integrated billing triggers. Data were retrieved using Current Procedural Terminology codes for billed POCUS examinations during the study period. We also collected monthly hospital registry data to quantify ED visits to control for volume. We compared the number and per‐visit rate of POCUS documented using descriptive statistics and segmented linear regression before and after implementation of the workflow. Results In the 22‐month preimplementation period, 209,725 ED visits occurred. During this period, POCUS was completely documented in 13,514 or in 6.4% of ED visits. There were an average of 614 scans documented per month. In the 12‐month postimplementation period, 97,418 ED visits occurred. During this period, POCUS was completely documented in 10,001 visits, or 10.3% of ED visits. There were an average of 833 scans documented per month. Linear regression analysis showed a significant increase in average monthly POCUS documentation of 265.34 scans/month (95% CI 150.60–380.09, p < 0.001) at the time of the intervention. Conclusions In this single‐center study, POCUS documentation increased by more than 60% following the implementation of a user‐centered POCUS workflow that reduced the burden on the clinician by automating data entry, improving data flow between ultrasound machines and the EHR and integrating billing.

show abstract

Prevalence of Phantom Scanning in Cardiac Arrest and Trauma Resuscitations: The Scary Truth

Boivin,

Xu,

Doko

et al. 2023

pocus

View full text Add to dashboard Cite

Background: The prevalence of phantom scanning, or point of care ultrasound (POCUS) performed without saving images, has not been well studied. Phantom scanning can negatively affect patient care, reduce billed revenue, and can increase medicolegal liability. We sought to quantify and compare the prevalence of phantom scanning among emergency department (ED) cardiac arrests and trauma resuscitations. Methods: This was a single center, retrospective cohort study from July 1, 2019, to July 1, 2021, of all occurrences of POCUS examination documented on the resuscitation run sheet during cardiac arrest and trauma resuscitations. Two investigators reviewed the run sheets to screen for POCUS documentation. Instances where documentation was present were matched with saved images in the picture archiving and communication system. Instances where documentation was present but no images could be located were considered phantom scans. A two-tailed student’s t test was utilized to compare the phantom scanning rate between cardiac arrest and trauma resuscitations. Results: A total of 1,862 patients were included in the study period, with 329 cardiac arrests and 401 trauma resuscitations having run sheet documentation of POCUS performance. The phantom scanning rate in cardiac arrests and trauma resuscitations was 70.5% (232/329) and 86.5% (347/401), respectively (p < 0.001). Conclusion: Phantom scanning is common in both cardiac arrests and trauma resuscitations in the ED at our institution, but is significantly higher in trauma resuscitations. Further research is needed to assess causes and develop potential solutions to reduce the high prevalence of phantom scanning.

show abstract

Description of the Use of Incentives and Penalties for Point-of-Care Ultrasound Documentation Compliance in an Academic Emergency Department

Cited by 5 publications

References 9 publications

Success of implementation of a systemwide point‐of‐care ultrasound privileging program for emergency medicine faculty

Success of implementation of a systemwide point‐of‐care ultrasound privileging program for emergency medicine faculty

Implementation of an automated, user‐centered point‐of‐care ultrasound workflow improves documentation and billing

Prevalence of Phantom Scanning in Cardiac Arrest and Trauma Resuscitations: The Scary Truth

Contact Info

Product

Resources

About