Emergency Care

Use of bedside ultrasound by hospital emergency departments is not yet common practice in California

A survey of California hospitals found that bedside ultrasound is only in the early stages of diffusing into the daily practice of emergency medicine in the State. Those emergency departments (EDs) involved in resident training (academic EDs) were more likely to use bedside ultrasound to evaluate patients than were EDs that had no training programs (community EDs). The academic EDs with bedside ultrasound also had a higher fraction of ED physicians credentialed for the technology than community EDs (60 vs. 41 percent of physicians).

The researchers contacted all California EDs that had in-house coverage by a physician around the clock. All of the 293 EDs surveyed responded to the 2-question primary survey (did they use bedside ultrasound and did they train ED residents). Bedside ultrasound was used in some form by 34 percent of the EDs. Sixty-eight percent of the 40 academic EDs in the State used bedside ultrasound compared with 29 percent of the 253 community EDs. Overall, 92 percent of hospital EDs using bedside ultrasound had equipment solely for their own use, 5 percent of the hospitals shared the equipment with the radiology department, and 3 percent of the hospitals had other arrangements.

Focused examination with sonography for trauma (FAST) and scans of the liver, heart, aorta, and pelvis were indications for bedside ultrasound use in more than 70 percent of the EDs. Community EDs were less likely than academic EDs to use bedside ultrasound for aortic or renal indications, or for basic or advanced procedures. The proportion of hospitals with full-time bedside ultrasound devices did not differ between academic and community EDs. However, only a third of all EDs using bedside ultrasound had a quality assurance program in place for monitoring the accuracy of interpretation by emergency physicians.

The study was funded in part by the Agency for Healthcare Research and Quality (HS15569). More details are in "A survey of bedside ultrasound use by emergency physicians in California," by John C. Stein, M.D., Gerin River, B.A., Irina Kalika, M.D., and others in the June 2009 Journal of Ultrasound in Medicine 28, pp. 757-763.

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