World Journal of Emergency Medicine.2020;11(1):12-17. doi:10.5847/wjem.j.1920-8642.2020.01.002
BACKGROUND:
Point-of-care ultrasound (POCUS) has become increasingly integrated into
the practice of emergency medicine. A common application is the extended focused assessment
with sonography in trauma (eFAST) exam. The American College of Emergency Physicians has
guidelines regarding the scope of ultrasound in the emergency department and the appropriate
documentation. The objective of this study was to conduct a review of performed, documented and
billed eFAST ultrasounds on trauma activation patients.
METHODS:
This was a retrospective review of all trauma activation patients during a 10-month
period at an academic level-one trauma center. A list comparing all trauma activations was crossreferenced
with a list of all billed eFAST scans. Medical records were reviewed to determine whether
an eFAST was indicated, performed, and appropriately documented.
RESULTS:
We found that 1,507 of 1,597 trauma patients had indications for eFAST, but
396 (27%) of these patients did not have a billed eFAST. Of these 396 patients, 87 (22%) had
documentation in the provider note that an eFAST was performed but there was no separate
procedure note. The remaining 309 (78%) did not have any documentation of the eFAST in the
patient’s chart although an eFAST was recorded and reviewed during ultrasound quality assurance.
CONCLUSION
A significant proportion of trauma patients had eFAST exams performed but
were not documented or billed. Lack of documentation was multifactorial. Emergency ultrasound
programs require appropriate reimbursement to support training, credentialing, equipment, quality
assurance, and device maintenance. Our study demonstrates a significant absence of adequate
documentation leading to potential revenue loss for an emergency ultrasound program.
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