Table Of ContentUltrasound
Program
Management
A Comprehensive Resource for
Administrating Point-of-Care,
Emergency, and Clinical Ultrasound
Vivek S. Tayal · Michael Blaivas
Troy R. Foster Editors
123
Ultrasound Program Management
Vivek S. Tayal • Michael Blaivas • Troy R. Foster
Editors
Ultrasound Program
Management
A Comprehensive Resource for
Administrating Point-of-Care, Emergency,
and Clinical Ultrasound
Editors
Vivek S. Tayal Michael Blaivas
Department of Emergency Medicine Department of Emergency Medicine
Carolinas Medical Center St. Francis Hospital
Charlotte, NC Columbus Georgia
USA University of South Carolina School
of Medicine
Troy R. Foster Columbia, SC
Lutheran General Hospital USA
Park Ridge, IL
USA
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I am deeply appreciative of my family,
especially my two wonderful children, Rajan
and Sita, for their patience, forbearance, and
participation in my professional activities to
empower clinicians at the bedside through
the power of ultrasound. I also wish to
recognize my patients, my colleagues, and
my mentors for allowing me to contribute to
the progress of medicine and healing during
the emergency condition.
Vivek S. Tayal, MD
To Laura, Kira, Adelaide, and Lilia. The
reason, inspiration, drive, and support
behind everything.
Michael Blaivas, MD
Dedicated to my wife, Kat, for her tireless
support of my never-ending projects.
And to my two young daughters, Maya
and Cora, who remind me that life is about
playing, not work.
Troy R. Foster, MD
How to Use this Book
Clinicians face increasingly sicker and more complicated patients than ever before
and physicians need access to life-saving technology. In the past two decades, ultra-
sound has become increasingly available at the bedside making tremendous impacts
in patient care and patient safety. However, creating a successful ultrasound pro-
gram that provides education, equipment management, and quality control is often
the barrier that prevents this life-saving technology from reaching patients. Without
a sound management program, point-of-care ultrasound (POC US) use is disorga-
nized, unregulated, and unsafe.
As physicians, we hope to positively impact our patient’s lives with innovative
healthcare. As educators and administrators, our impact can be exponential, espe-
cially with a well-designed and a well-run ultrasound program providing our col-
leagues with ultrasound availability and future physicians with vibrant training.
Program directors confront many challenges when constructing their program
starting with finding the right equipment to incorporating a successful workflow
process. It is difficult to gather all the needed information and advice to make
competent decisions without having to learn everything through trial and error. To
overcome this burden, the editors enlisted an impressive legion of expert authors
and compiled decades of cumulative experience. Now in one place, ultrasound
directors have a comprehensive resource.
The Editors’ goals are to provide all the tools necessary to make a program
successful beginning with a conceptual framework and then providing specific
templates and tools. The editors understand that program development and
management is dynamic as national policies and available tools change. At the time
of publication, this book is as current as possible. It also provides reference websites
to keep you, the US program director, abreast of new developments.
In this first edition, we made some editing decisions that reflect the evolution in
US practice and philosophy of the US management courses we have directed. First,
the chapters in this book cover many subject areas, many of which overlap. We
made a conscious decision to allow overlap, so that the reader did not have to move
to another chapter for reference to a topic. However, individual topics are fully
explored in their home chapter. Second, the topics are independent of experience
vii
viii How to Use this Book
level, so novice program directors may wish to follow our advice for the fundamental
chapters. Third, as true in any area of knowledge, there will be practice, technical,
regulatory, reimbursement, and legal changes that require you to correlate subject
matter with current statutes.
Fourth, we have substitute POC US for the many terms for this field including clini-
cal, clinician-performed, focused, emergency, critical, bedside, physician-performed,
and others. Time will resolve the varying nomenclature. Finally, US is based on tech-
nology which changes at breakneck speed and alters practice and management.
Evolution of Program Management
POC US is relatively new and during its infancy it was a challenge for the program
directors to manage. Traditional users have had a system set up with archiving, bill-
ing, and hospital policy. Bedside ultrasound used in the emergency department,
intensive care units, and offices did not enjoy previously designed pathways for
privileging, reimbursement, and archiving. As emergency physicians started to use
this US technology, it became apparent that successful implementation of an ultra-
sound program required more than hands-on training and interpretation skills.
Education on program management was needed to provide the key components to
safe and effective diagnostic and procedural ultrasound.
In 2004, sponsored by a grant from the American College of Emergency
Physicians, Dr. Vivek Tayal organized the first Emergency Ultrasound Management
Course which had the mission to provide ultrasound program directors the tools to
set up a well-functioning program. Now, several other courses offered around the
United States also offer education regarding program management.
The course was the first recognized resource for emergency room ultrasound
directors to learn the multifaceted components of program development. The faculty
instructors were experts in their respective material including the core topic, the
Ultrasound Director, given by Dr. Mike Blaivas.
Other specialties also recognize the need of program management and have included
management education during their hands-on ultrasound courses, such as the American
College of Chest Physicians Ultrasound Course at their national simulation center.
Although a few other small courses exist with a program management component
and a few textbooks briefly introduce the basics of program management, there is no
comprehensive guide to this topic. Thus, this book is relevant to the continued
growth of POC US.
Starting Point and Section Organization
Dr. Tayal’s introductory chapter is your first priority. It is a global perspective on
clinician-performed bedside ultrasound. Be sure to digest this important chapter as
your first task to becoming an informed ultrasound director.
How to Use this Book ix
The early chapters of this book focus on the leadership of your program whether
in your department or institution.
The second section centers on education at all levels recognizing that smaller
machines have made ultrasound available for medical students to advanced practi-
tioners. It even includes a section on ultrasound simulation, a growing educational
tool.
The third section provides detailed logistics on equipment, maintenance, and
safety. This is, by far, the most practical section for useful information and advice
immediately applicable to your program.
In the fourth section, we focus on the engine of a program, which is the quality
improvement program. We devoted a chapter to workflow process which should get
considerable attention of any new ultrasound director. For those with limited bud-
gets we also offer a section on practical operating and educational solutions.
The fifth section offers insight into hospital level credentialing, quality assur-
ance, national politics, and recent issues with accreditation. This is followed by
reimbursement and coding, which hands you the monetary keys to pay for your
program.
The last section covers topics in specialized communities. Chapters focus on
ultrasound in pediatrics, critical care, community, and office-based practices.
Finally, the book covers ultrasound programs in emergency medical services and
the global health effort.
If the reader is starting a program from the ground floor, the editors recommend
reading first the chapter titled: Ultrasound Director. The next steps are acquiring
equipment, establishing a privileging pathway, providing education for the physi-
cian staff, and setting up quality assurance. A crucial component to easing the work-
load is a smooth functioning workflow solution. These are the priority chapters the
editors recommend for fledgling programs.
Novel program recommended chapters
Chapter 2: Ultrasound Director
Chapter 12: Equipment Purchase
Chapter 5: Introductory Education
Chapter 16: Quality Assurance
Chapter 17: Workflow and Middleware
At whatever point your program is in its development, we make the promise to
you that this book will give you the conceptual building blocks and ample specific
details to take your program to the next level.
Park Ridge, IL Troy R. Foster, MD
Contents
1 Initial Approach to Ultrasound Management: Making Ultrasound
Meaningful from the Start . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Vivek S. Tayal
Section 1 US Leadership
2 Ultrasound Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Michael Blaivas
3 Job Search and Contract Negotiations . . . . . . . . . . . . . . . . . . . . . . . . . 29
Laura Oh
4 Institutional Point of Care Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . 37
Gerardo Chiricolo and Vicki E. Noble
Section 2 US Education
5 Introductory Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Brian B. Morgan and John L. Kendall
6 Continuing Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Molly E.W. Thiessen and Resa E. Lewiss
7 Undergraduate Ultrasound Education . . . . . . . . . . . . . . . . . . . . . . . . . 69
David P. Bahner and Nelson A. Royall
8 Residency Ultrasound Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Laura Nolting and Thomas Cook
9 Ultrasound Fellowship Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Christopher C. Raio and Srikar Adhikari
xi
xii Contents
10 Point of Care Ultrasound Issues for Advanced Practice Providers
and Nursing Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Eric J. Chin and Shane M. Summers
11 Simulation Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Bret P. Nelson and Dan Katz
Section 3 US Machines and Equipment
12 Ultrasound Equipment and Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Rachel Liu, Christopher L. Moore, and Vivek S. Tayal
13 Ultrasound Equipment Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Andreas Dewitz
14 Ultrasound Associated Materials and Equipment . . . . . . . . . . . . . . . . 225
Matthew Lipton and Robinson M. Ferre
15 Ultrasound Safety and Infection Control . . . . . . . . . . . . . . . . . . . . . . . 243
Jason T. Nomura and Arun D. Nagdev
Section 4 US Workflow
16 Ultrasound Quality Improvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
Patrick S. Hunt, Christopher David Wilbert, and Zachary T. Grambos
17 Workflow and Middleware. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Christopher J. Bryczkowski and Mark W. Byrne
18 Practical Operating and Educational Solutions . . . . . . . . . . . . . . . . . . 301
Petra E. Duran-Gehring and Alfredo Tirado-Gonzalez
Section 5 US Program Politics, Recognition, and Value
19 Politics of Point of Care Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Paul R. Sierzenski
20 Credentialing and Privileging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Robert Jones
21 Accreditation in Point of Care Ultrasound . . . . . . . . . . . . . . . . . . . . . . 337
Michael P. Mallin
22 Point of Care Ultrasound Reimbursement and Coding . . . . . . . . . . . 345
Jessica R. Goldstein and Stanley Wu
