Emergency Ultrasound Section Forum
US Machines per Patient Volume
I'm SURE this question has been addressed in the past so my apologies for redundancy, but what's the general consensus on the number of machines you need per so many patients? In other words do you generally need 1 machine per 20K pts? 30k pts? I know there will be a large range here, depending on pt acuity, the overall use in your department/clinical setting, etc. Also, any of you involved in residency training: I would assume the number of machines (in an ideal world) goes up if you're involved in residency training (assuming residents are doing more scans than the average EM physician in community practice..)
Thanks for the feedback.
I don't know of any "ideal" number since it is highly dependent on how often your physicians use ultrasound in their daily practice, your trauma burden (since this usually means you need a machine "immediately") and if you have medics/nurses starting US guided peripheral IVs.
In my experience (at several different teaching institutions), most adult EDs have around 1 machine per 20k-25k annual patient census. Our visits are currently just over 70k and with 3 machines (and medics starting US guided peripheral IVs) its seems difficult to find a machine not in use these days. However, in our peds ED, with an annual census around 55k, the machine is usually gathering dust unless I'm using it.
Our medics and nurses have been starting US guided peripheral IVs over the past 18 months and this has really increased machine usage, particularly as more and more medics become trained. Infact, I would say that some days this probably accounts for 1/3 of all studies/procedures being performed throughout the day.
It would be interesting to see how this affects machine usage in other EDs out there...
Robinson M. Ferre, MD, FACEP
Director, Emergency Ultrasound Division
Associate Program Director, Emergency Ultrasound Fellowship
Assistant Professor, Department of Emergency Medicine
I asked this same question approximately 4 years ago and the numbers that Rob gave was the general consensus. Additionally though, many pointed out, that if you department is geographically separated or if a machine has to stay in a certain area (trauma bay) you should have a machine for each location.
We see approximately 60k. We have 3 machines. One that sits in the trauma bay 24/7 and then two in the main ED. We are building a fast track area that will be adjacent but separate from the main critical care ED. We are requesting a 4th machine for this area due to the separation.
Jared Marx, MD
We have 6 machines for 55K patients p.a.
This means that we almost always have a machine available, but not necessarily the one you “want” … some machines are preferred for vasc access/MSK, some for cardiac, some for endocavitary, etc.
I would not want to have <4 in service at any time, which means we would need at least 5, since it is not uncommon for a machine to be out of service. Plus the extra machine(s) mean that we have resources for teaching, which would be impossible if we only had 4.
Anthony J. Dean, MD, FAAEM, FACEP
Associate Professor of Emergency Medicine and Associate Professor of Emergency Medicine in Radiology
Director, Division of Emergency Ultrasonography
Department of Emergency Medicine
University of Pennsylvania Medical Center
I agree with Rob, trying to figure out how to acquire machines based on ED volume is tough due to provider usage variability.
What I have done over the years is to find ways to get a new machine in the department for specific reasons when the opportunity arises.
1) starting a residency program ( training of existing faculty and incoming residents)
2) teaching PA/RN/EMS IV access
3) fast track integration
4) hospital building a new unit in the ED ( essentially a blank check for whatever machine you want as part of construction budget)
5) need for upgrade from “old” technology for safety / quality reasons (can’t afford to miss something due to poor image quality / built in wireless for seamless workflow)
6) other sections of the ED develop a need… ( trauma, pediatrics, holding area, step down, etc..)
7) revenue from POCUS justifies another system
affordable care act #ultrasoundfirst
9) more fellows ( applicable to NYC alone..)
Rajesh N Geria, MD