CREDENTIALING ISSUES IN EMERGENCY ULTRASONOGRAPHY
Section snippets
TRAINING AND CREDENTIALING GUIDELINES
At the crux of the debate is whether emergency physicians are qualified to provide this service and the criteria by which emergency physicians can achieve training and credentialing in emergency ultrasonography. A number of specialties make use of a variety of ultrasound applications, and each has adopted a particular approach to train and credential its members. For instance:
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The American College of Cardiology recommends 3 months of training and performing 120 ultrasound examinations.6, 14
PATHS TO BECOMING CREDENTIALED IN EMERGENCY ULTRASONOGRAPHY
It should be noted that credentialing is a hospital issue. The credentials committee of a particular hospital credentials its physicians to provide various services, including ultrasonography. Consequently, an emergency physician credentialed to perform emergency ultrasonography in one institution may not be credentialed to do so in another institution. Emergency departments that desire to credential their members in emergency ultrasonography must be prepared to meet the terms of the
QUALITY ASSURANCE
Once members of the emergency department are on the path to credentialing in emergency ultrasonography, emergency ultrasonography must be incorporated in the emergency department's and the hospital's quality improvement or quality assurance process. At the Lincoln Medical Center, a sample of 30% of ultrasound examinations will be compared with the previously-mentioned gold standards and reviewed jointly with the department of radiology. The purpose of this joint review is to ensure that the
STRATEGIES FOR EMERGENCY DEPARTMENTS SEEKING TO PERFORM EMERGENCY ULTRASONOGRAPHY
The following suggestions may facilitate the process of incorporating ultrasonography into emergency medicine practice:
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Document all cases where the lack of immediate access to ultrasonography hindered patient care.
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Request that the radiology department provide around-the-clock service, and in a CQI forum, document all cases where the emergency department's and patients' needs were not met.
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As the ultrasound debate will take place in the credentials committee, it will therefore be very
CONCLUSION
Despite the current debate over whether emergency physicians are qualified to perform limited, goal-oriented emergency ultrasonography, the fact remains that this modality has already been adopted as part of the emergency medicine armamentarium.
This can be documented by the following list. Portable ultrasound is listed in the Core Content for Emergency Medicine, the basis for residency curricula that represents the scope of emergency medicine practice. The development and publication of
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(1984) - American College of Emergency Physicians: Council Resolution on Ultrasound. ACEP News, November...
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Cited by (30)
Emergency ultrasound of the gall bladder: Comparison of a concentrated elective experience vs. longitudinal exposure during residency
2013, Journal of Emergency MedicineCitation Excerpt :Although recognizing the role and value of EUS training integrated longitudinally into the residency curriculum, the ACEP guidelines also acknowledge the value of specialized, intensive courses for physicians in community practice (3). However, it is unknown how such intensive courses compare with a longitudinal experience spread over several years of residency training, and there has been controversy about the best models for ultrasound training because the American Institute of Ultrasound in Medicine recommends 100 didactic hours and 500 ultrasound examinations for training in multiple applications (4–6). Therefore, the purpose of this study was to compare the accuracy of EUS of the gall bladder done by physicians after a 2-week EUS elective to similarly numbered examinations done by physicians longitudinally over several years of residency training.
Emergency Department Ultrasound Credentialing: A Sample Policy and Procedure
2009, Journal of Emergency MedicineCitation Excerpt :They covered the goals of an ED ultrasound program, the scope of practice, credentialing requirements, and quality improvement. Lanoix, also in 1997, discussed similar issues, and offered some strategies to help convince the hospital administration of the important role of bedside emergency sonography (9). By 2001, the American College of Emergency Physicians (ACEP) produced guidelines for emergency ultrasound, a tremendous step forward in terms of helping EDs with the credentialing process (1).
Operator Confidence Correlates with More Accurate Abdominal Ultrasounds by Emergency Medicine Residents
2007, Journal of Emergency MedicineCitation Excerpt :Consistent with their data, our data demonstrate an improvement in the accuracy of FAUS with greater operator confidence among relatively inexperienced residents. We did not attempt to correlate confidence with post-graduate year of training because none of the existing training guidelines are based on years of training, but rather a minimum number of training examinations (4,6,10–12). Furthermore, it was previously shown that post-graduate year of training did not influence confidence or accuracy apart from the number of studies previously done (14).
Minimum training for right upper quadrant ultrasonography
2004, American Journal of Emergency MedicineGeneral practitioner's skills to perform limited goal-oriented abdominal US examinations after one month of intensive training
2002, European Journal of UltrasoundNonradiologists reading radiographs: Good medicine or stretching the scope of practice?
2001, Journal of Cardiothoracic and Vascular Anesthesia
Address reprint requests to Richard Lanoix, MD, 210 West 107 Street, Apt 4D, New York, NY 10025
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From the Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, New York