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Need for Follow-up Ultrasounds Reduced When Radiologist Interprets ED Test

Radiologists still interpret most of emergency department-ordered ultrasounds, and a new study suggests there is a good reason why: They appear to be more cost-effective.

In fact, the study presented at the American College of Radiology annual meeting, suggests that the need for follow-up imaging is substantially less when the initial ED ultrasounds are interpreted by a radiologist instead of a non-radiologist, such as an emergency physician.

Researchers from the Harvey L. Neiman Health Policy Institute used 5% Medicare data files from 2009 through 2014 to identify ED patients undergoing ultrasound examination and also to determine whether the initial test was interpreted by a radiologist or another physician. The study team then added together all additional imaging for each of the patients over the next 7, 14, or 30 days.

After analyzing 200,357 ED ultrasound events, researchers found that 81.6% were interpreted by radiologists. Yet results indicate that across all study years, ED patients with ultrasounds interpreted by non-radiologists had an average of 1.08 more imaging studies within seven days, 1.22 within 14 days, and 1.34 within 30 days of the initial ED ultrasound.

Overall, the researchers found, subsequent imaging was 34% less likely when the initial ED ultrasound examination was interpreted by a radiologist vs. a non-radiologist. In addition, while the volume of future imaging for both radiologists and non-radiologists decreased between 2010 and 2014, the study found that the significant differences persisted depending on who was doing the interpretation.


"While the causes of this difference are not clear, the previously documented higher use of limited ultrasound examinations by non-radiologists or a lack of confidence in the interpretations of non-radiologists may potentially explain this increase in follow-up imaging examinations," suggests co-author Bibb Allen Jr., MD, FACR, chair of the Neiman Institute advisory board.

"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."