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Ideal Ultrasound Machine Features for the Emergency Medicine and Critical Care Environment-2008
Compact
size
Fits well in patient rooms with multiple tasks occurring
Width
and
depth
of the machine should be kept to a minimum
Easily mobile - wheels should be high quality and multidirectional
Reasonable weight
While certain situations may benefit from true portability, most ED applications are best served by a well designed cart based system
Image quality and versatility
2-D image quality is essential, especially in difficult/overweight patients
Quality across many applications:
General abdominal
High quality wide footprint probe
Pelvic/obstetrical
Endocavitary/transvaginal pelvic probe
Cardiac
True phased array probe capability with tissue harmonic imaging
Vascular, skin, soft tissue, lung, procedural
Versatile, broadband, high frequency linear transducers
Multiple live ports that allow easy switching between transducers on the same patient (at least 3, ideally 4 ports)
Ideal monitor articulates in all directions with bright flat screen viewable from multiple angles
Ease of use
Quick boot up time
Option for battery powered sleep
At least 2-3 hours of battery powered scanning
mechanism to allow notification that battery is running down
Cold-boot time is still very important
Straightforward "first grade" keyboard and screens. Backlit, large print, large buttons. Multiple users (as many as 60 or more in many residency programs)-means any small non-intuitive feature is magnified.
Consider "burying" more advanced features, ? pullout keyboard
Initial screen should be straightforward
Buttons that should be emphasized (and separate)
On/off
Start exam
Patient info
Examiner info
Exam type
Reason for exam
Probe selection
Depth
Gain
Freeze
Measure
Calculations
Record (loop/still/video)
End Exam
Exam findings
Generate report
Transmit report/images
Durability
and
service
The ED is a harsh environment but demands 24/7 uptime
Equipment and probes should be built and expected to survive being dropped, stepped on, bled and vomited on - crevices should be avoided, a sealed keyboard is very desirable
Probe holders should be stable, strong, easily cleaned
Parts that may be broken should be separate and easily replaceable
Service needs to be accessible and prompt 24/7
A call on Friday afternoon may be at the end of the service technician's week, but it is just the beginning of a weekend full of traumas for the ED
Option for affordable service
Either included service (five years) OR discounted price up front with service contract paid for yearly
Different pricing options allows options for negotiation with hospital
Windows based systems should be extensively tested and bulletproofed to avoid software malfunctions
Versatility in
image archival
options. EDs vary widely in how they review and archive images
DICOM should be standard on any machine, but alternative image archival options should be available
Still image options
Ability to print images
Ability to save still images on internal hard drive
Ability to export images in both DICOM and more widely usable format (jpeg, bitmap) to: external hard drive/jumpdrive/CD/DVD
Ability to incorporate images into reporting packages or an electronic medical record (EMR)
Video image archival options
Ability to save cineloops to hardrive
Ability to easily and quickly export both DICOM and more widely usable video formats to external hard drive/jump drive/CD/DVD
Ability to output multiple video formats to a recording device: coaxial, S-video, HDMI
On keyboard control and review of recorded images, i.e. for DVD recorder
Ideally, the option to record real time video (not loops) as direct digital information to a DVD. This would allow true video without analog loss that is immediately archived
Integration of image and image management with workflow (see below). Method for easily taking images and information off of machine and associated with patient info for external CQI/educational review.
Workflow
and image reporting. Workflow is essential to running an effective emergency ultrasound program in terms of medicolegal documentation, reimbursement, quality assurance, and education. Customizability and non-proprietary systems are ideal.
Front end workflow:
getting information into the machine regarding: who is doing the scan, who the scan is being done on, what type of scan is being done, and why.
Wireless interface with hospital ADT systems that allows all patient information to be matched and accurately entered with minimal user effort: ie, barcode reader, or selecting patient from list of patients in the department.
Customizability
is extremely desirable. Different workflow environments may require certain elements prior to scanning, and have other options available. However other areas may only add to "noise" on an initial screen. The option to include (and require) elements at the director's discretion would be a significant advantage.
One possibility: Microsoft Access (or Filemaker for Mac users) type database structuring-ie, creating fields and designing a form that would allow customizable fields and formatting as well as flexible output.
Back end workflow:
Getting information out of the machine and into the patient record and/or a database for CQI. Includes all front-end workflow elements as well as images and findings.
Again, customizable, non-proprietary-ability for director to structure which elements are required for a report of findings, with baseline findings designed per ACEP guidelines. Ability to generate a customizable, non-proprietary CQI database, with images/loops linked to records.
Ability to output (wirelessly) into printable and robust reimbursable medicolegal format, .pdf, etc.; ability to interface/ input into electronic medical record
Ability to take large amounts of information out of the machine and have it removed from the machine at that point - for example for a set of dates - ie, without having to individually highlight and delete.
The images should be able to be post processed allowing emergency image capture and then proper credentials applied to the image thereby preventing "unverified" image transfer
The necessary steps to get the patient into the radiology information system (RIS) and accessible via the DICOM worklist are time prohibitive in some emergency situations
In these situations, post processing of the images is required to attach at least the correct accession number
Other options discussed in the main document, such as bar coding, may help in these situations
DICOM
and wireless connectivity. DICOM worklist access and image archival represent unique challenges in the emergency department setting. The emergency paradigm is different in that the machine will be used by multiple users, be taken to the bedside of the patient, and will not always be able to have correct demographics of the patient in emergency situations. The ideal solution is to have wireless communication between the ultrasound machine and DICOM servers.
The wireless communication should be compatible with recognized 802.11 wireless standards
The system should have the ability to communicate on both the 802.11a and 802.11b/g/n standards for maximum compatibility
The system should have a minimum of Wi-Fi protected Access (WPA) security features
"Medical grade" security enhancements are welcomed and encouraged
The wireless radio should be included and internal to the machine, either as an option or standard
External radios are currently the norm, but are subject to failure, theft, and in some cases are grossly underpowered (ie, USB radios)
The radio should be adequately powered so that only a minimal amount of wireless infrastructure will be required to maintain wireless reception
Setup should be easily accessible and user friendly to allow minimal setup and maintenance
Those with administrator privileges should be able to easily access, change, and repair the wireless settings preventing dependence on IT or PACS teams to fix these settings
The settings should be easy to import and export for those cases of "loaner" machines and upgrades
Should be configurable to an existing PACS system or a local computer server
In many situations non-traditional imaging specialists are excluded from access to the PACS.
Should be allowed an alternative configuration to archive to a local server
Other attractive features
Storage
options, ie, drawer(s) for: sterile probe covers, special angiocaths, towels, gel, etc.
Battery powered gel warmer that recharges when machine is plugged in
Retractable or easily stored cords (preferably in a separate area for each probe).
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