ED POCUS Workflow

Two Workflow Pathways. There are two different workflows depending on the credentialing status of the provider. The EMSL has yet to convey how we determine who is credentialed and able to bill for POCUS.

Credentialed Physician Staff and APPs working with them

  1. STEP ONE – place the order in Epic Use either the “ED POCUS” quick list, an ED POCUS order embedded in an ED panel or order set. (Note: this will not bill unless you click “credentialed provider” when you document findings)
  2. STEP TWO – load the study on the ED ultrasound machine Hit “End” to terminate any prior study. Press “Patient” and then “Worklist” to bring up the worklist. Select your patient/order. Then hit “Import” to load the order and patient demographics onto the machine.
  3. STEP THREE – scan the patient Record clips (preferred) and images of the required views (see views and confirmation sheet). Hit “End” to end study when finished. Because you have placed an order, these images are sent directly to PACS, QPath and the Patient Portal
  4. STEP FOUR – hit “End” again As above, if your study isn’t ended, you run the risk of having saving subsequent patients’ images in your study.
  5. STEP FIVE – document in the procedure section of your note In the “My Notes” section, select “ED POCUS” on the sidebar (under provider note and procedure notes). Then click on “Enter Result” for the study you ordered. Use the appropriate POCUS documentation template.

Non-credentialed Staff or APP

  1. STEP ONE – DO NOT place an order in Epic
  2. STEP TWO – Manually Enter Patient Demographics Hit “End” to terminate any prior study. Press “Patient” and then enter your name as “Operator”. If you are an APP with an attending working with you, put their name under “Interpretation”.
  3. STEP THREE – scan the patient Record clips (preferred) and images of the required views (see views and confirmation sheet). Hit “End” to end study when finished.
  4. STEP FOUR – hit “End” again As above, if your study isn’t ended, you run the risk of having saving subsequent patients’ images in your study.
  5. STEP FIVE – Send your study to QPathE for review Because there is no order for non-credentialed studies, you need to push the study to QPathE from the ultrasound machine. This can be done in “iStation”
  6. STEP SIX – document in the procedure section of your note Document your POCUS findings in the ED Provider note using a smartphrase (they all start with .US).

Here is a quick overview of the workflow with detail below the fold or on the Northwell EMSL one pager and tipsheet. In addition there is a Demo Video available to guide you.

PLEASE DISREGARD THIS PRIOR WORKFLOW

In the Epic orders tab there is a quick list for ED POCUS exams. Select and order the study or studies that you are going to perform. In addition, some ED Panels and Order Sets have POCUS orders embedded which can be used as well.

Then complete all required fields in the order. Most should be pre-selected. This should just be entering the reason for the exam.

STEP TWO – load the study on the ED ultrasound machine

Once the order is placed, the study will be added to all of our machines’ worklists. On the machine, click on “Patient”. This will start the process of gathering patient’s demographics and parameters for the study.

Hit the worklist button to open the worklist of POCUS studies that have been ordered. Do not use the “Patient List” button. Although it seems like this might be appropriate, it will not bring you to the next screen.

Hitting “Worklist” should bring up the list of studies that have been ordered by patient name. Select the patient you plan to scan. This image has had the patient ID and accession numbers removed for this example.

Then hit import. This will load all of the patient demographics and study parameters and allow you to scan. This will open the demographics page where you can add an interpreting physician but don’t delete patient identifiers, etc…

STEP THREE – scan the patient

Scan your patient. Remember to save clips and/or images of any pathology noted. For a normal study without obvious pathology, all of the required views should be saved in two planes. Be sure to clean machine with grey wipes and plug it back in in Room 11.

STEP FOUR – hit “End” again

Hit End. This can be difficult to remember, but failure to do this leaves the door open to have yourself or the next provider accidentally save images from the wrong patient to this study.

STEP FIVE – document in theprocedure section of your note.

Why document findings? Documenting point of care ultrasound is important to ensure communication with colleagues and ensure quality.

Document your findings. From the “My Notes” section, select the “ED POCUS” section.

Choose the template for your study. This will open a page where you can choose “Enter Result”

Choose the POCUS application (FAST, echo, lungs, etc…) and complete the worksheet and all hard stops.

If you are credentialed to bill for the study, you can check “Yes” for the Credentialed Provider prompt,

If you are not credentialed to bill – you must check “No”. Please do not check credentialed inappropriately, or you may bill for something inappropriately.

Sign your procedure note when done.