Emergency department ultrasound — practical and political

Editorials / Commentaries

CJEM 1999;1(2):121-122

Practically speaking, bedside ultrasound is well within the scope of emergency physicians (EPs) and is gaining acceptance. The literature supports the use of limited, goal-directed ultrasound in the diagnosis of many emergent conditions. EPs should use ultrasound as a tool to answer specific questions (e.g., Is there blood in the belly?); they should not surf the body for clues. ED ultrasound offers rapid evaluation of potentially life-threatening conditions and the opportunity for serial examinations in selected cases.

Politically speaking, we have a problem for which we, alas, are not blameless. Cardiology, gynecology, surgery and particularly radiology have an interest in what we do. We have surged ahead enthusiastically without the requisite preparation. Our approach is like suturing a wound before administering the anesthetic. Introducing ultrasound covertly by organizing emergency physician in-services will, without doubt, lead to failure. First we must lay the groundwork and prepare our plan. Most questions will come from radiology and can be anticipated. Other departments (e.g., surgery, gynecology) may lend support. The medical executive and senior management should be on board.

The goal is to build a solid base of support and open the lines of communication. The plan must be fully developed and promoted. A good machine should be purchased and a network of other groups supporting ED ultrasound should be encouraged. Documentation must allow for peer review and feedback. Continuous quality improvement (CQI) is essential to the success of an ultrasound program. EP credentialing should be encouraged.

In sum, ED ultrasound is the right thing to do. Political hurdles should be anticipated and overcome by openness, planning, networking and a rigorous CQI process.