Ultrasonography in Community Emergency Departments in the United States: Access to Ultrasonography Performed by Consultants and Status of Emergency Physician-Performed Ultrasonography


Study objective: Nearly all emergency medicine residency programs provide some training in
emergency physician–performed ultrasonography, but the extent of emergency physician–performed
ultrasonography in community emergency departments (EDs) is not known. We seek to determine the
state of ultrasonography in community EDs in terms of access to ultrasonography by other specialists
and performance of ultrasonography by emergency physicians.

Methods: A 6-page survey that addressed access to ultrasonography performed by other specialists
and emergency physician–performed ultrasonography was designed and pilot tested. A list of all US ED
directors was obtained from the American College of Emergency Physicians. Twelve hundred of 5264
EDs were randomly selected to receive the anonymous survey, with responses tracked by separate
postcard. There were 3 mailings from Fall 2003 to Spring 2004.

Results: Overall response rate was 61% (684/1130). Respondents who self-reported as being
academic with emergency medicine residents were excluded from further analysis (n=35). A sensitivity
analysis (reported in parentheses) was performed on the key outcome question to adjust for response
bias. As reported by ED directors, ultrasonography was available in the ED for use by emergency
physicians at all times in 19% of EDs (12% to 28%), with an additional 15% (9% to 21%) reporting a
machine available for use by emergency physicians in some capacity and 66% (51% to 80%) reporting
that there was no access to a machine for emergency physician use. ED directors reported being
requested or required to limit ultrasonography orders performed by radiology in 41% of EDs, with less
timely access to radiology-performed ultrasonography in off hours. Of EDs with emergency physician–
performed ultrasonography, the most common applications were Focused Assessment with
Sonography for Trauma (FAST) examination (85%), code situation (72%), and check for pericardial
effusion (67%). Of physicians performing ultrasonography, 16% stated they were currently requesting
reimbursement (billing). The primary reason cited for not implementing emergency physician–
performed ultrasonography was lack of emergency physician training. For the statement ‘‘emergency
medicine residents now starting residency should be trained to perform and interpret focused bedside
ultrasonography,’’ 84% of ED directors agreed, 14% were neutral, and less than 2% disagreed.

Conclusion: Community ED directors continue to report barriers to obtaining ultrasonography from
consultants, especially in off hours. Nineteen percent of community ED directors report having a machine
available for emergency physician use at all times; however, two thirds of EDs report no access to
ultrasonography for emergency physician use. A majority of community ED directors support residency
training in emergency physician–performed ultrasonography. [Ann Emerg Med. 2006;47:147-153.]

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