More Follow-Up Ultrasounds Performed when Nonradiologists Interpret

Downstream, or follow-up, imaging after an initial ED ultrasound is significantly reduced when the ultrasound examination is interpreted by a radiologist rather than a nonradiologist, according to a study published in the Journal of the American College of Radiology.

Researchers from Alabama, Virginia, Georgia, and New York studied differences in imaging utilization downstream to initial emergency department (ED) ultrasound examinations interpreted by radiologists versus nonradiologists.

Using 5% Medicare data files from 2009 through 2014, the researchers identified episodes of care in which the place of service was "emergency room hospital" and the patient also underwent an ultrasound examination. They determined whether the initial ultrasound was interpreted by a radiologist or a nonradiologist and then summed all additional imaging events occurring within 7, 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.

The results showed that of 200,357 ED ultrasound events, 163,569 (81.6%) were interpreted by radiologists and 36,788 (18.4%) by nonradiologists. Across all study years, ED patients undergoing ultrasound examinations interpreted by nonradiologists underwent additional diagnostic imaging studies compared with patients whose examinations had been interpreted by a radiologist:

From 2010 to 2014, the volume of downstream imaging for both radiologists and nonradiologists significantly decreased, with each year resulting in 0.08 fewer imaging examinations 14 days after the ED ultrasound event. Despite that decline, differences in downstream 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," lead author Bibb Allen Jr., MD, FACR, chair of the Neiman Institute advisory board, said in a release. "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.”