Performance, Training, QualityAssurance, and Reimbursement ofEmergency Physician–PerformedUltrasonography at Academic MedicalCenters

Moore CL, Gregg S, Lambert M(Yale University, New Haven, CT; Resurrection Medical CenterEmergency Medicine Residency, Chicago, IL)J Ultrasound Med. 2004;23:459-466

Background: Ultrasonography has become a widely used

diagnostic tool inmanyspecialties. However, the amount and

character of the training required to attain competence in

performing and interpreting ultrasonography remain a con-

troversial issue. In recent years, hospital privileging and

credentialing issues have gained prominence. Emergency

physician–performed ultrasonography is increasingly being

incorporated into the curriculum of emergency medicine

residency programs in the United States. Bedside emer-

gency physician–performed ultrasonography has been

shown to be helpful in diagnosing and excluding a variety of

emergent conditions. The purpose of this study is to assess

the current state of bedside emergency physician–per-

formed ultrasonography in terms of prevalence, training,

quality assurance, and reimbursement at emergency medi-

cine residency programs.

Methods: A 10-questionWeb-based surveywas e-mailed to

ultrasonography/residency directors at 122 emergency

medicine programs in the United States.

Results: The response rate was 84%. Of the programs

responding, 92% of programs reported that 24-hour emer-

gency physician–performed ultrasonography was available.

A slight majority of programs (51%) reported that a creden-

tialing/privileging planwas in place at their hospital, and 71%

of programs had a quality assurance/image review pro-

cedure in place. Guidelines specific to emergency medicine

for 150 ultrasonographic examinations and 40 hours of

instruction were met by 39% and 22% of residencies,

respectively, although only 13.7% of programs were com-

ABSTRACTS

Characteristics of Occasional andFrequent Emergency Department Users:Do Insurance Coverage and Access toCare Matter?

Zuckerman S, Shen Y-C(Urban Institute, Washington, DC)Med Care. 2004;42:176-182

Background: Between 1992 and 2001, emergency depart-

ment (ED) visits increased by 20% in the United States.

However, in any given year, most people do not use an ED.

Research has shown that, in 1999, about 1 in 5 adults sought

care at an ED, with approximately 7% seeking ED care 2 or

more times during the 12-month study period. The current

study investigated how insurance coverage, access to care,

and other individual characteristics are related to differ-

ences in ED use among the general population.

Methods: Data were obtained from the 1997 and 1999

National Survey of America’s Families, a nationally repre-

sentative sample. Based on number of ED visits during the 12

months preceding the survey, people were classified into 3

groups: non-ED users (with no visits), occasional ED users

(with 1 or 2 visits), and frequent ED users (with �3 visits). A

multinomial logit model was used to estimate the effect of

insurance status and other factors on ED use levels.

Findings: Persons with fair or poor health were 3.64 times

more likely than others to be frequent users compared with

nonusers. Uninsured and privately insured adults had the

same risk of being frequent users. However, publicly insured

adults were 2.08 times more likely to be frequent users.

Adults making 3 or more visits to physicians during the 12-

month period were 5.29 times more likely to be frequent ED

users than those making no visits to physicians.

Conclusion: Contrary to popular belief, the uninsured do not

appear to use ED care more than insured populations. In

addition, frequent ED users do not appear to use ED visits as

a substitute for primary care visits. Rather, they are a less

healthy population who need and use more care overall.

Comment: This nicely done study emphasizes a couple of

important points: (1) frequent users of the ED are sicker and

probably more chronically ill than non-ED users or occa-

sional ED users; (2) adhering to the simplistic idea that

decreasing ED visits for nonurgent problems will fix ED

crowding ignores the real issue: our health care system is

5 5 4

broken; and (3) ED crowding needs to be addressed on

multiple fronts.

Rita K. Cydulka, MD, MS

doi:10.1016/j.annemergmed.2004.08.031

ANNALS OF EMERGENCY MEDIC INE 44 : 5 NOVEMBER 20 04