Often patients are subjected to follow-up imaging. According to new research by the Harvey L. Neiman Health Policy
Institute, the use of follow-up imaging is significantly less when
initial emergency department (ED) ultrasound examinations are
interpreted by a radiologist than a nonradiologist.
The study is
published online in the Journal of the American College of Radiology
The researchers used 5% Medicare data files from 2009 through
2014 to identify episodes of care where the place of service was
"emergency room hospital" and the patient also underwent an ultrasound
‘The use of follow-up imaging is significantly less when initial emergency department (ED) ultrasound examinations are interpreted by a radiologist than a nonradiologist.’
They determined whether the initial ultrasound was
interpreted by a radiologist or a nonradiologist and then summed all
additional imaging events occurring within seven, 14 and 30 days of each
initial ED ultrasound. The mean number of downstream imaging procedures
was calculated by specialty group for each year and each study window.
"We found that of 200,357 ED ultrasound events, 81.6% were
interpreted by radiologists and 36,788 by nonradiologists," said Danny
R. Hughes, Neiman Institute senior director for health policy
research and senior research fellow.
Hughes and his colleagues discovered that across all study years, ED
patients with ultrasounds interpreted by nonradiologists underwent 1.08
more imaging studies within seven days, 1.22 more imaging studies
within 14 days, and 1.34 within 30 days of the initial ED ultrasound
event. For both radiologists and nonradiologists, the volume of
subsequent imaging decreased over time. Despite that decline,
differences in follow-up imaging between radiologists and
nonradiologists persisted over time.
"While the causes of this difference are not clear, the previously
documented higher use of limited ultrasound examinations by
nonradiologists or a lack of confidence in the interpretations of
nonradiologists may potentially explain this increase in follow-up
imaging examinations," said Bibb Allen Jr., lead study author
and chair of the Neiman Institute advisory board.
Allen added that further analysis will be necessary to fully
elucidate the causes of the discrepancy since resource use will be a
critical metric in federal health care reform.
"Since emerging federal health reform includes cost and resource use
as part of the Medicare Quality Payment Program, emerging patterns of
care such as point of care ultrasound should include resource use in
outcomes evaluation. Efforts toward improving documentation of findings
and archiving of images as well as development of more robust quality
assurance programs could all be beneficial."