The Future of Better Patient Care


Bradley Rosen, MD, MBA, FHM, addresses participants in the “Portable Ultrasound for the Hospitalist” pre-course.

Bradley Rosen, MD, MBA, FHM, addresses participants in the “Portable Ultrasound for the Hospitalist” pre-course.

GRAPEVINE, Texas—Hospitalist Michael Monge, MD, of Cogent Healthcare in San Bernardino, Calif., watched an instructor squeeze the lubricating gel on the transponder and press it gently, but firmly, into the crook of a woman’s arm. Veins practically popped off an ultrasound monitor, serving as a literal road map for vascular access.

And he thought: Wouldn’t it be great if I had this technology all the time, just like I remember from my residency?

“A lot of my ER attendings were able to do a study at the bedside in a manner of minutes, not 30 or 45 minutes,” says Dr. Monge, who practices at Saint Bernardine Medical Center. “If they saw something abnormal, sure enough, they got the full study. But they were able to get that glimpse. Ultimately, it’s just better patient care.”

Dr. Monge’s ultrasound lesson was a first for the SHM annual meeting. In past years, training on ultrasounds was wrapped into the “Medical Procedures for the Hospitalist” pre-course. But at HM11, thanks to the growing prevalence and portability of the technology, the training was expanded into its own half-day pre-course, appropriately dubbed “Portable Ultrasound for the Hospitalist.”

“The ultrasound will be the stethoscope of the 21st century,” says Mark Ault, director of the Division of General Internal Medicine and assistant chairman for clinical affairs of the Department of Medicine at Cedars-Sinai Medical Center in Los Angeles. “And the goal will be to have an ultrasound in the hands of every internist.”

Only time will tell whether portable ultrasound becomes as commonplace as Dr. Ault envisions, but what is clear is that the evolution of the technology makes it widely applicable to hospitalists, says Bradley Rosen, MD, MBA, medical director of the Inpatient Specialty Program (ISP) at Cedars-Sinai Medical Center.

Pricing is one such example. In years past, ultrasound machines were bulky and costly, with price tags in the hundreds of thousands of dollars. Now, portable units, depending on the number of transducers and functionality, can come as low as $20,000, though more-advanced machines quickly jump into the $40,000 to $60,000 range.

HM11 attendees listen to Kevin Felner, MD, during the “Advanced Interactive Critical Care” pre-course.

HM11 attendees listen to Kevin Felner, MD, during the “Advanced Interactive Critical Care” pre-course.

Still, Dr. Rosen views the practical uses of the technology as almost endless, and could include vascular access, placing central and PICC lines, and insertion and removal of catheters. Most hospitalists, however, continue to have limited experience with portable ultrasound, meaning those interested in learning more likely have to seek out physicians in other departments to provide the training and mentorship required. Dr. Rosen suggests working with ED physicians, OB-GYNs, and radiologists, although he notes you should be careful to be clear that the HM community is not looking to supplant anyone, or take billing opportunities away.

Hospitalists “don’t know how to use it, and people don’t know where to go to learn how to use it,” he says. “This is a starting point that will allow people … to take these ideas back and, hopefully, generate enough of a critical mass that it becomes a louder and louder chorus asking for this technology.”

More from the HM11 Special Report

Texas-Sized Excitement

HM11 galvanizes hospitalists from all career stages, inspires take-home action

The Future Is Forward

As HM matures, movement turns attention to quality goals, resource management, and value propositions

HM=Improved Patient Care

Healthcare heavyweights confident hospitalists will make a difference

The Suggestions Box

Special Interest Forums provide hospitalists helpful hints, partnerships

Pediatric Perils

Balanced, risk-based approach appropriate for ALTEs

Something for Everyone

HM11 attendees get the most out of educational and networking offerings

HM11 Breakout Sessions Roundup

Highlights from faculty presentations at HM11 May 11-13 in Grapevine, Texas

Utilizing Technology to Improve the Clinical and Operational Performance of Hospitalists

Recruiting and Retaining Hospitalists: Developing a Talent Facilitation Framework

Patient Satisfaction: Tips for Improving Your HCAHPS Scores

The Role of Hospital Medicine in Adapting to the New ACGME Requirements

Skin is In: Dermatological Images Every Hospitalist Should Recognize

The How, When and Why of Noninvasive Ventilation

This Disease Is Easy; It’s the patient Who’s Difficult

The Art of Clinical problem-Solving: Mystery Cases

You may also be interested in these ONLINE EXCLUSIVES:

Listen to new SHM President Joseph Li's goals

Dr. Li, associate professor of medicine at Harvard Medical School and director of the hospital medicine division at Beth Israel Deaconess Medical Center in Boston, shares his thoughts about his presidency and the future of HM

Listen to HM11 faculty discuss portable ultrasound and new ACGME rules

HM11 pre-course faculty Brad Rosen, MD, FHM, believes portable ultrasound technology will impact HM in a positive way; Jeffrey Schnipper, MD, MPH, FHM, talks about new rules on resident duty hours and patient caps

Next Article:

   Comments ()