With the transition to Epic, we have moved to an order based workflow for point of care ultrasound imaging. Here is a quick overview of the workflow with detail below the fold.
- STEP ONE Place the POCUS order in Epic. (this will not bill unless you click “credentialed provider” when you document findings)
- STEP TWO Select the order from the worklist on the machine.
- STEP THREE Scan your patient. Record clips (preferred) and images of the required views (see views and confirmation sheet). Hit “End” to end study when finished.
- STEP FOUR – Be sure you hit “End” to end the study. Failure to do so may allow the next provider to accidentally add images from another patient to your study.
- STEP FIVE – Document your findings and interpretation in the provider note under procedures.
STEP ONE
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.
STEP TWO
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 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.
STEP FOUR
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 your findings. In the “Procedures” tab of Epic notewriter, chose the “POCUS” button to find the ultrasound documentation templates.
Why document findings? Documenting point of care ultrasound is important to ensure communication with colleagues and ensure quality.
Before selecting the appropriate POCUS documentation template, you can make note of the imaging being inadequate — for example, you tried to look at the gallbladder but it was obscured by bowel gas.
If you are credentialed to bill for the study, you can check “Credentialed Provider”. Please don’t check this if you aren’t credentialed or you may bill for something inappropriately.
Choose the template for your study, fill it out and sign it.