CREDENTIALING ISSUES IN EMERGENCY ULTRASONOGRAPHY

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Emergency medicine has incorporated many techniques borrowed from other specialties into its armamentarium. These include the use of paralytic agents for emergency airway management, anesthetic medications for conscious sedation, proctoscopy and sigmoidoscopy, slit-lamp examination, and fiberoptic laryngoscopy. Conflicts over who should perform and bill for procedures have resulted from crossing specialty boundaries. The current debate over the use of ultrasonography by emergency physicians is another example of such a battle.

Few would disagree that patients believed to have an acute pericardial effusion, an abdominal aortic aneurysm, free peritoneal fluid, or an ectopic pregnancy should have access to ultrasonography. This diagnostic modality has the potential to confirm or exclude these diagnoses accurately, rapidly, and inexpensively, regardless of the time of day the patient presents to the emergency department. As the number of ultrasound technologists and radiologists are insufficient to provide widespread availability of ultrasonography 7 days a week, 24 hours a day, there is a strong impetus for emergency physicians to provide this service.8

In 1990, the American College of Emergency Physicians (ACEP) published a position statement supporting the availability of diagnostic ultrasonography 24 hours a day, 7 days a week, and that emergency ultrasonography should be performed by appropriately trained physicians, including emergency physicians.1 A similar statement was passed by the Society of Academic Emergency Physicians (SAEM).19

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:

  • 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:

  • 1

    Document all cases where the lack of immediate access to ultrasonography hindered patient care.

  • 2

    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.

  • 3

    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

References (20)

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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 Medicine
    Citation 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 Medicine
    Citation 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 Medicine
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    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 Medicine
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Address reprint requests to Richard Lanoix, MD, 210 West 107 Street, Apt 4D, New York, NY 10025

*

From the Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, New York

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