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Bedside Ultrasound, A Cultural Shift in Imaging

The St. Paul's Ultrasound Department has innovated the delivery of ultrasound scans for the critically ill. According to Cathy Fix, RDMS, Ultrasound Supervisor, "We are changing the current culture from a departmental base of care to a patient focused model of care to increase patient safety, reduce expenditure and expedite diagnosis."

Conventional ultrasound machines are bulky and heavy, making them difficult to move and maneuver. These units have to be connected to an electrical outlet in order to operate, and require a cable network connection. They need to be shut down, unplugged and cords wrapped up before being moved between patients. The reboot time can be as long as 5 minutes making conventional ultrasound machines inconvenient to use as bedside units.

Furthermore, transporting the critically ill patient is risky, labour intensive and removes them from access to support systems. Almost all ICU patients are intubated or have IV lines, so there is a risk of tubes being pulled out. A physician, nurse, respiratory technologist and porter are required to accompany these patients, leaving the ICU short staffed. In addition, up to 25% of these patients have infections that require isolation precautions. Moving these patients can potentially spread infection to other areas of the hospital.

Also, scanning the critically ill patient from the ICU in the Ultrasound department is a cost prohibitive and time-consuming endeavor. The time required to prepare these patients for transport can be a minimum of 40 minutes. According to Cathy Fix, "the estimated cost for moving these patients at St. Paul's Hospital in 2007 was $35,800.00. The Ultrasound department leaves a room open and has a sonographer on standby for a minimum of one hour. This created increased wait times for already scheduled outpatients, leading to a revenue loss for the Ultrasound department estimated at $49,800.00 in 2007."

Conversely, small lightweight bedside ultrasound units allow for superb image quality, due to technological advances in faster microprocessors and the freedom of wireless connectivity. The St. Paul's Ultrasound Department is currently using a Zonare ultrasound machine for their bedside work. It is considered a green machine, as the unit uses less power than a standard ultrasound machine and is powered by long-lasting rechargeable batteries.  It does not have to be shut down when moving between patients because it doesn't need to be plugged in, making it convenient to move.

A qualified and experienced sonographer takes the ultrasound unit directly to the patient's bedside to perform the ultrasound exam. This allows for patient focused care, limits the spread of infection, increases productivity and improves workflow.

In addition, scanning ICU patients at the bedside alleviates the risks involved in moving these patients, thus improving patient safety and limiting the transmission of infection.

Furthermore, images are sent wirelessly over a secure 802.11i network connection to the reporting radiologist while the exam is in progress. The sonographer in ICU can communicate their findings directly with the radiologist back in the ultrasound department by cellular phone during the exam. The radiologist can immediately dictate a report, which is then available to the physician in ICU, aiding in an efficient and timely diagnosis.