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Solving revenue capture for POCUS - The importance of workflow management

by Gus Iversen, Editor in Chief | November 30, 2020
Dr. John Hipskind
HealthCare Business News sat down with Dr. John Hipskind, ultrasound GME director and ultrasound fellowship director at Kaweah Delta Medical Center to discuss the advantages of point-of-care ultrasound.

From reducing phantom scans, to easing credentialing and QA processes, and improving revenue overall, the technology has created tremendous opportunities for improvement at his facility.

HCB News: Tell us a bit about Kaweah Delta Medical Center. What kind of institution is it, and what’s the surrounding environment like?
Dr. Hipskind: We’re a 581-bed hybrid academic and Level III Trauma designated community hospital and Level III Trauma Center with 42 emergency department beds located in California’s Central Valley. We serve a catchment area of about half a million people, although the city we’re in, Visalia, has a population of around 125,000. In terms of annual volume, we were inching toward 100,000 patients early this year before COVID, but we’ll probably end the year around 75,000 visits

Our community has historically had poor access to care—we may not be a county hospital but we are definitely a safety net hospital. Years ago, we were finding it difficult to recruit enough physicians to serve our patients, as the Central Valley is quite a different place than your San Diego or L.A. In order to draw talented people here we started up a residence program in emergency and family medicine, launching the program 7 years ago. We now have 13 residents a year in that program, and more than 120 residents across all of Kaweah Delta’s departments. This past year we launched our own ultrasound fellowship program.

HCB News: With your residency program and trauma center status in mind, can you talk a bit about any specific point of care ultrasound (POCUS) workflow needs you have?
Dr. Hipskind: Well in short, we’re treating a large, often underserved patient population; we have a mission to train new physicians; and our role in the community means we need to secure enough revenue to maintain our sustainability.

Let’s start with the training aspect. We do about 400 point-of-care ultrasound scans every month in the ED, although things have of course fluctuated with COVID. To use those scans for training, though, we need an efficient way to mark interesting cases and to revisit residents’ scans to offer feedback on their techniques and interpretations. While all hospitals have PACS systems, those are often separate from the hospital email program and not automatically compliant with patient privacy regulations. Before our old system was sunsetted and we adopted Sonosite’s Synchronicity, it was nearly impossible to go back retrospectively and find a case a particular attending did with a particular resident—and if you did find it, you had to open your email program separately, still maintaining compliance, to share any tips. When there are barriers like those to timely, accurate feedback, it’s just not as beneficial to learners. You’re losing out on important recommendations and on effective changes they might have made.

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