The increasing use of bedside ultrasound reflects a shift in the way emergency department physicians approach their role in patient care. Emergency physicians at Yale Medicine use ultrasound machines to observe in real time what’s happening in a patient’s body.
Not only do bedside ultrasounds give physicians vital, specific information when making a diagnosis and designing a course of treatment, the process enriches the interaction between doctors and patients. “The real benefit of bedside ultrasound is that the provider asking the questions, performing the physical exam, and most invested in the care of that patient is the one performing the ultrasound exam," says Rachel Liu, MD, a Yale Medicine Emergency Medicine physician. "Therefore, there’s no loss in translation between different providers."
What is a bedside ultrasound?
Why might a doctor administer a bedside ultrasound?
- To save time: Doctors can diagnose patients based on a targeted examination, then pursue treatment options rapidly according to what they find. The process is more efficient than the alternative—waiting for imaging results that may be more comprehensive but may delay treatment.
- To save lives: Sometimes a serious, urgent, and potentially worsening condition may be the cause of seemingly innocuous symptoms. Bedside ultrasounds help doctors evaluate all the possibilities, and occasionally they find something unexpected. Performing an ultrasound on a patient with back pain, says Dr. Liu, may reveal an abdominal aortic aneurysm that is rupturing or leaking. "Now, instead of sending the patient home with ibuprofen, you’re calling the vascular surgeon, the patient is going to surgery and a life-threatening emergency was picked up because of your bedside ultrasound.”
- To support procedures: Healthcare providers perform minor procedures while patients are in the emergency department, and for some procedures, such as placing an intravenous catheter (or central line) to administer medication and fluids, ultrasound is a great help. Using ultrasound for procedural guidance, says Dr. Liu, has decreased complication rates of inserting central lines, and is now a standard of care. "You could do it the old way—the blind way. There’s been good success with that after training. But if you have technology that can decrease your complication rates, using it is truly patient-centered care.”
How is a bedside ultrasound different from a traditional ultrasound?
- It’s faster. During the traditional ultrasound process, a physician orders imaging, the patient goes to the radiology department, undergoes the scan, returns to the emergency department, and waits for the results. Bedside ultrasounds require no transit time or wait time. The patient benefits from immediate, efficient imaging.
- It’s administered by a physician. Because physicians take the medical history, conduct the exam, and diagnose the patient, it makes sense that they be the ones correlating their ultrasound findings with the rest of their evaluation. Bedside ultrasound allows the physician to share information directly with the patient about exactly what’s going on in real time. Patients can see their own anatomical structures and the areas the physician is focusing on.
- It’s used to answer specific questions. The bedside ultrasound provides targeted information that will assist with diagnosis and treatment. Traditional imaging tends to take a more comprehensive approach, says Dr. Liu, and it works to answer more global questions about what’s happening in the patient’s body. “Our exams are not as comprehensive as a radiology exam,” Dr. Liu says. “But that’s because the radiology comprehensive exams essentially look at almost everything, whereas we’re looking specifically for certain conditions that may impact a patient’s prognosis and subsequent management in a very short time frame.”
What are the benefits of bedside ultrasound?
- Patient education: When doctors can see what’s going on inside a patient’s body in real time, they can talk the patient through what’s happening, educate him or her on the current status, and explore next steps together. “The patient can see what’s going on, too, if they choose to look,” says Dr. Liu. “It lets us communicate better with our patients and do education and teaching sessions with our patients instead of having to rely on reports.”
- No radiation: Unlike other kinds of imaging, such as X-rays and computerized tomography (CT) scans, ultrasound technology doesn’t use radiation. “Twenty years ago, CTs were proliferating. Nobody really thought a whole lot about radiation exposure,” Dr. Liu says. “Now the pendulum is swinging back the other way to prevent risks to patients.”