Improving the Efficient use of Ultrasound by Emergency Medicine Providers

Purpose: The aim of this project is to understand and identify the ordering practices of Ultrasound (US) exams from Emergency Department (ED) providers. The goal is to reduce the number of multiple US exams ordered to assess a specific acute indication. The primary purpose is identification and reduction of overloaded resources, including: technologists, radiologists, patient time in the ED, and the financial burden to patients and families.

Methods/Materials: Outcome Measure: The accuracy of diagnosis without missed diagnosis
Process Measure: Reduction in the number of multiple US exams ordered by ED providers
Balancing Measure: Appropriate ordering of US exams by ED providers specific to acute indications

A manual chart review was performed to determine patients receiving multiple US exams ordered within 30 minutes of one another, in addition to other imaging using ionizing radiation (X-rays and CT).

Results: Mid-level ED providers tend to order multiple US exams simultaneously that are not specific to the indication.
Additional imaging is also performed (X-rays and CT).
A significant number of patients have no findings from US exams.
Many patients are found to have moderate to large stool burden that could have been discovered with a single abdominal X-ray prior to US exams.
An intervention by ED leadership addressing the issue resulted in a reduction of multiple US orders by over 30%.
The results were readily identifiable following the intervention, and maintained for the final 5 months of the study.

Conclusions: Mid-level ED providers may benefit from a more refined assessment of ED patients with abdominal pain that lack other indications of a more serious issue.
Following the intervention, ordering practices in the ED changed immediately.
Patient care has not suffered by reducing the number of US exams.
Ongoing monitoring of ED provider ordering practices will continue.