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Ultrasound at the point of care: who's in charge?

From the June 2011 issue of DOTmed HealthCare Business News magazine
This report originally appeared in the June 2011 issue of DOTmed Business News

By David Willis

One in three hospitalized patients may suffer medical errors or other adverse events, a rate ten times higher than previous estimates, according to a new study published in the April issue of Health Affairs. Another study in the same issue reported medical errors cost the US health care system $17.1 billion in 2008. Taken together, these findings offer powerful evidence that administrators and physicians need to work harder to improve the quality and safety of health care.

Ultrasound at the point of care may be part of the solution. Yet as the use of ultrasound becomes more integrated into medical specialties, it also becomes more of a flashpoint in the long-simmering turf war between radiologists and non-radiologists.

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Turf wars
According to an August, 2010 special report in Emergency Medicine News, ”Radiologists and Emergency Physicians Still Debating Who Should Hold the Ultrasound Probe,” the new turf war is unlike the old. A driving force seems to be the evolving applications of the technology that have lead to misunderstandings on the part of some radiologists, leading them to perceive an encroachment on their traditional domain when there is actually an opportunity for radiologists and non-radiologists to work together in new ways to improve the quality and safety of health care. The report pointed out that better understanding of the benefits of emergency ultrasound, for example, would be “a win-win for the hospital system.”

So how do we achieve this solution? Let’s examine the facts about ultrasound at the point of care. Advances in ultrasound equipment have made it possible to use this powerful, safe technology around the world –and beyond--in settings as diverse as the International Space Station (where astronauts were trained, with expert medical guidance, to perform ultrasound examinations) to the Mount Everest base camp (where ultrasound has been used to diagnose high-altitude pulmonary edema) and battlefield medicine (where portable ultrasound devices can be employed to rapidly check wounded soldiers for internal bleeding and other potentially life-threatening conditions.)

Some radiologists have contended other physicians lack the necessary expertise to use ultrasound visualization, The May/June 2009 issue of Health Imaging & IT reported, “Some radiologists remain concerned about the efficacy of the growing use of ultrasound in the [emergency department],” due to the need for seasoned reading skills required to properly diagnose the patient and recommend a treatment plan. A similar disagreement erupted in 2010, in the online publication Medscape Radiology, with radiologists and emergency physicians debating whether non-radiologists should perform ultrasonography.
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