Last month, HCA, the nation’s largest health care company, adopted a comprehensive program based on ACEP guidelines that allows their network of 172 hospitals to incorporate bedside emergency ultrasound.

With more than 6 million patient visits annually at HCA hospitals, the Advancing Clinical Ultrasound Toolkit will enhance patient care and accelerate innovation in community emergency medicine nationwide.

“The HCA Advancing Clinical Ultrasound project is unprecedented in emergency medicine,” said Dr. John Kendall, an adviser to the project and past chair of ACEP’s Ultrasound Section.

“It identifies a tool to improve patient care and then provides the start-to-finish direction for emergency physicians wanting to establish a strong program,” he said. “In my opinion, it will have a measurable and lasting impact on the care of emergency department patients.”

Dr. Stephen Hoffenberg, an ACEP member from Denver, along with 15 other emergency physicians and HCA quality experts, created the program.

There were several key factors for HCA and the emergency physicians in creating this program, Dr. Hoffenberg said, including:

• Recognizing bedside ultrasound as an important quality initiative and an advancement in the safety and efficiency of emergency patient care;
• Developing comprehensive tools to facilitate new program implementation for those emergency groups choosing to adopt ultrasound technology, as well as to standardize existing programs;
• Recognizing specialty-specific standards as published and endorsed by ACEP as the basis for training, hospital credentialing, and application selection in emergency medicine; and
• Focusing on patient care and safety, rather than hospital politics and physician economics.

The effort started in the fall of 2008 when the ED Physician Advisory Council (EDPAC) and the HCA Quality Department undertook an in-depth evaluation of “Clinical Ultrasound,” Dr. Hoffenberg said. The effort defined clinical ultrasound as those ultrasounds performed by clinicians at the bedside, within the context of clinical care, interpreted as images are displayed and utilized for immediate clinical decision making or for procedure guidance. Clinical ultrasound was thus differentiated from traditional consultative imaging services and was acknowledged as a patient-centered, safe, efficient, and effective modality.

the initiative will provide hundreds of emergency physicians with the tools and support to provide this lifesaving technology.

A variety of specialties using clinical ultrasound were recognized, such as anesthesia, critical care, pulmonary medicine, trauma surgery, and more. However, the project’s focus has been on emergency medicine. HCA based its program on multiple ACEP emergency ultrasound documents, including the guidelines, imaging compendium, and coding and reimbursement documents (available at www.acep.org).

The group defined program elements that would drive the highest quality for start-up ultrasound programs, as well as decrease the variability in programs that were already in operation. HCA did not expect that all emergency physician groups will utilize bedside ultrasound. But for those that did, HCA supplied a full array of tools, information, and an implementation plan to put a program into effect.

If HCA recommendations are followed, historical barriers to program development could be avoided, said Dr. Hoffenberg. Additionally, groups and hospitals desiring emergency ultrasound will not have to recreate processes on a facility-by-facility basis.

The toolkit was completed in January, along with a plan to introduce the work-product with:

• A printed document compendium.
• A Web-based plan for program implementation that includes tasks, responsible parties, timetables, and necessary resources, all linked to the compendium.
• An archived Webcast.
• A Powerpoint for institutional presentations regarding clinical ultrasound use.

Topics specifically addressed in the toolkit include: program goals, quality management, scope of practice, training and proficiency, emergency ultrasound director, delineation of privileges, professional practice evaluation, equipment selection, equipment maintenance and cleaning, coding and documentation, financial impact, and ACEP resource documents.

“Although most are familiar with the benefits of emergency ultrasound, it is an enormous help to not only have the endorsement of HCA but also their direct assistance with promoting this technology in their emergency departments,” said Dr. Jason Gukhool, an emergency physician from Houston, Texas and member of the task force.

“As emergency ultrasound is gaining interest among practicing emergency physicians and new graduates are coming out with ultrasound training integrated into their practice, we have seen a dramatic increase in the demand to offer these services in our emergency departments,” he said.

Dr. Gukhool added that HCA’s emergency ultrasound initiative will provide hundreds of emergency physicians with the tools and support to provide this lifesaving technology to the patients they serve.

Other ACEP members involved in the effort included Dr. Carl Menckhoff, Dr. Kayur Patel, Dr. Michael Liao,

Dr. Catherine Erickson, Dr. Jonathan Theoret, and Dr. Geoff Sanz. Suzanne Stone-Griffith, R.N., M.S.N., AVP Quality at HCA, was the principal quality and process expert for the project.