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ED Throughput and #POCUS for Ectopic/IUP

January 19, 2017 0 Comments

Here’s the next study that was reviewed by Dr Tom Jelic at the latest EDE 3 Online Journal Club. It is a study by Wilson and his colleagues in California. They looked at the difference in ED length of stay when the pelvic ultrasound was done in radiology vs. when it was done by the emergency physician. See below for further discussion on the topic.

 

There are quite a number of studies (Burgher, Blaivas, Rodgerson) that have looked at the effect of POCUS on throughput vs. elective ultrasound in the past. The extra 2 hours for the elective ultrasound is pretty standard.

Let’s flesh out pelvic ultrasound a bit more and look at some barriers.

The first barrier is having an endocavitary probe. There are a number of EDs in Canada that have run into resistance in trying to get this probe. This include some academic EDs and even one entire province. The details vary from place to place, but in the end, these attempts at blockage have one common feature. They are bogus.

Another perceived barrier is time. In light of the study by Wilson, this is paradoxical. It takes no more than 2 minutes to perform a pelvic POCUS. This was shown in this study a few years ago. Yet the perception among some emergency physicians is that it is more time-consuming than that. If you spend the 2 minutes doing the scan, you will save about 2 hours on the patient’s ED length of stay, because in most cases, the patient will not require an elective ultrasound during that visit.

In some EDs, as in the emergency department in Sudbury, the endocavitary probe is kept locked up as part of the cleaning process. Although it sounds like a big barrier to its use, it shouldn’t be. In our ED, the probe is properly cleaned by a ward aide. It is then locked in a cabinet in close proximity to that part of our ED where we are most likely to use it. When we need it, we just request that the ward aide bring the probe to the patient’s room. Practically speaking, the most efficient way to get that done and still maintain flow is to request the probe, then go see another patient, then go back and do the scan. In most cases, you can then discharge the patient home.

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