Harbor:Rules for Performing ED Ultrasounds

Formal US in the ED[1]

  • All studies should be performed in the ED unless the techs are simultaneously attempting to perform multiple ED studies.
  • 2 US techs are generally assigned to the ED at night, and ED studies are given priority over inpatient studies.


Bedside US

Always know ahead of time if the exam you are doing is "for the record" or for "training" only. ANY EXAM WHICH FACTORS IN ANY WAY INTO THE CARE OF YOUR PATIENT OR INTO YOUR DECISION MAKING AT ANY POINT IS "FOR THE RECORD"

"For the Record" Exams[2]

  1. Your attending MUST be approved in the exam you are doing EVEN if you also are. If your attending is not, you cannot do the exam. Ask your attending. If not sure, check WikEM Ultrasound Approval List.
    1. https://www.wikem.org/wiki/Harbor:Ultrasound_approval_list
  2. If you are approved in the exam you may perform the exam and report and use the results without any attending over-read if you are confident with the results.
  3. If you are NOT approved, your approved attending MUST confirm your findings BEFORE you report your results verbally (including calling out results in a trauma or discussing with a consultant) or in writing.
  4. All "for the record" exam images must be uploaded to Synapse (except in cases where there isn't time to create an order). If you can't upload - note why in your ultrasound procedure note.
  5. If you are not approved - your images should NOT be uploaded until reviewed by an approved attending.
  6. All for the record exams should be documented in an Ultrasound Procedure note, along with your approved attending's name. Please DO NOT put results in your H&P, other than to mention "see Procedure Note". Procedure notes are designed to prevent you from over reporting on findings you are not trained in.

If your exam does not meet all the criteria for a "for the record" exam, it must be treated as a "training" exam , and any findings can not be reported or used to make decisions.

"Training" Exams[3]

  1. Ask the patient for verbal permission to perform. These are not covered by the ED consent the patient signs.
  2. Never use info from a training exam for patient care decisions.
  3. Do not record anything about the exam in a procedure note or in the medical record.
  4. Do not upload any images from a training exam.
  5. If asked by a consultant or the patient or anyone else what the US shows - say only "I'm training so I'm not allowed to comment on what I think I see in the exam"
  6. During Trauma Activations - please delay training exams until after the initial resuscitation period, to avoid confusion. DO NOT CALL OUT RESULTS as the assumption will be that this was an exam "for the record".

See Also

References

  1. Katherine Tran, Rads US Supervisor, 11/29/18
  2. T. Jang, Dir. of ED Ultrasound 11/3/16
  3. T. Jang, Dir. of ED Ultrasound 11/3/16