Patient Care

Ultrasound More Common at the Bedside

A recent “Current Concepts” article in the New England Journal of Medicine (2011;364:749) by a pair of Yale University physicians asserts that the day is close at hand when ultrasound interpretations by clinicians at the patient’s bedside will become as routine in hospital care as the trusty stethoscope. Ultrasound, a noninvasive form of imaging related to oceanographic sonar, has moved beyond its traditional home in radiology to myriad other medical specialties and practice areas. The technology has become smaller, less expensive, and higher in resolution in recent years, the authors note, adding that it has been used on Mount Everest and the international space station, as well as in battlefield situations.

“It’s becoming more accessible, and more training is available to physicians who aren’t radiologists,” says Diane Sliwka, MD, a hospitalist at the University of California at San Francisco (UCSF).

Dr. Sliwka says the NEJM article represents a milestone in the dissemination of bedside ultrasound. She conducts monthly faculty development training in procedural ultrasound at UCSF, workshops at HM and internal-medicine conferences, and training sessions for other hospitals.

The most common uses for bedside, “point of care” ultrasound include guiding procedures, such as thoracentesis and paracentesis, with improved safety over doing such insertions “blind.” Emerging procedural uses include lumbar puncture and arthrocentesis. Diagnostically, bedside ultrasound can provide quick screening and assessment, for example, of fluid buildup around the heart; previously, it could take hours to get the results from a formal heart study.

As with the stethoscope, Dr. Sliwka says, training in its correct use and scope of appropriate bedside practice is essential: “My advice is to learn from the experts at your facility, including the radiologists, critical care, or emergency physicians.” Ultrasound courses are increasing at hospitalist conferences, but space often is limited, and further supervised practice back home is needed.

The next step for hospitalists could be the definition of appropriate scope of practice, training, and competencies for its use. “Creating a niche in this area can be a nice change of pace from our traditional work as hospitalists,” Dr. Sliwka says. —LB


Video Chat Takes Off for Physicians

Video Chat Takes Off for Physicians

A recent study of digital adoption trends found that 7% of U.S. physicians now use video consultations to communicate with patients.

Manhattan Research’s 2011 “Taking the Pulse” survey of 2,000 physicians’ use of technology found that video chat is emerging as a way to consult with patients about nonurgent issues and follow-up questions or with geographically dispersed patients. Psychiatrists and oncologists are more likely to use the new technology. Doctors’ concerns regarding reimbursement, liability, and HIPAA privacy rules remain barriers to adoption.

For more information, visit—LB


Positive Outcomes from Full Disclosure of Medical Errors

The University of Michigan Health System’s (UMHS) risk-management model of full disclosure with offer of compensation for medical errors sparked hospitalist Allen Kachalia, MD, JD, of Brigham & Women’s Hospital in Boston to retrospectively study the outcomes of malpractice-claims-related performance before and after UMHS implemented the system in 2001.

Among the results Dr. Kachalia reported in his research abstract plenary at HM10, and subsequently published in Annals of Internal Medicine (2010;153(4):213-221), the mean monthly rate of new claims per 100,000 patient contacts decreased 36% after the full-disclosure model was adopted, while the rate of claims resulting in lawsuits declined by 65%. Claims also were resolved more quickly with the full-disclosure model.

Disclosure of medical error, Dr. Kachalia says, means “if someone is injured by medical care caused by medical error, the physician tells the patient they made the error, how it happened, and, often, what they’ll do to fix it.” An apology is somewhat different, he adds, and there’s no generic script for an apology. “What patients want is sincerity,” he says.

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