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Does the use of bedside pelvic ultrasound decrease length of stay in the emergency department?
MedLine Citation:
PMID:  23283267     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVES: Diagnostic ultrasounds by emergency medicine (EM) and pediatric emergency medicine (PEM) physicians have increased because of ultrasonography training during residency and fellowship. The availability of ultrasound in radiology departments is limited or difficult to obtain especially during nighttime hours. Studies have shown that EM physicians can accurately perform goal-directed ultrasound after appropriate training. The goal of this study was to compare the length of stay for patients receiving an ultrasound to confirm intrauterine pregnancies. The hypothesis of this study is that a bedside ultrasound by a trained EM/PEM physician can reduce length of stay in the emergency department (ED) by 1 hour.
METHODS: This was a case cohort retrospective review for patients aged 13 to 21 years who received pelvic ultrasounds in the ED during 2007. Each patient was placed into 1 of 2 groups. Group 1 received bedside ultrasounds done by institutionally credentialed EM/PEM attending physicians. Group 2 received radiology department ultrasound only. Each group had subanalysis done including chief complaint, time of presentation, time to completion of ultrasound, length of stay, diagnosis, and disposition. Daytime was defined as presentation between 7 AM and 9 PM when radiology ultrasound technologists were routinely available.
RESULTS: We studied 330 patients, with 244 patients (74%) in the bedside ultrasound group. The demographics of both groups showed no difference in age, presenting complaints, discharge diagnoses, and ultimate disposition. Group 1 had a significant reduction (P < 0.001) in time to complete the ultrasound compared with group 2 (mean, 82 minutes [range, 1-901 minutes] vs 149 minutes [range, 7-506 minutes]) and length of stay (142 [16-2268] vs 230 [16-844]). Of those presenting during the day (66%), group 1 showed a significant reduction in length of stay (P < 0.001) compared with group 2 (220 [21-951] vs 357 [156-844]). Of those who presented at night (34%), group 1 showed a significant reduction in length of stay (P < 0.002) compared with group 2 (270 [16-2268] vs 326 [127-691]).
CONCLUSIONS: The use of ED bedside ultrasound by trained EM/PEM physicians produced a significant reduction in length of stay in the ED, regardless of radiology ultrasound technologist availability.
Authors:
Ravi Thamburaj; Adam Sivitz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatric emergency care     Volume:  29     ISSN:  1535-1815     ISO Abbreviation:  Pediatr Emerg Care     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-03     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8507560     Medline TA:  Pediatr Emerg Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  67-70     Citation Subset:  IM    
Affiliation:
From the Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, NJ.
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