Cost effectiveness of bedside ultrasound in pediatric ER care

A third-year medical student at the University of Louisville has now led a group of researchers from five universities in determining that bedside ultrasound is cost-effective as well.

With colleagues from Columbia University, Northwestern University, George Washington University, Jefferson Medical College and UofL, Alexander Thai will present results from the study, "Cost Effectiveness of Implementation of Point-of-Care Ultrasound in a Pediatric Emergency Department," at the American Academy of Pediatrics National Conference and Exhibition in San Diego.

Thai will make his presentation at the pre-conference Section on Emergency Medicine on Friday, Oct. 10, at 3:45 p.m. PDT.

Point-of-care ultrasound can generate positive operating revenue

The clinical value of bedside ultrasound -- known as "point-of-care ultrasound" or POCUS -- has long been established. What Thai and his colleagues, including In K. Kim, M.D., of UofL's Department of Pediatrics Emergency Medicine Division, found is that the high-tech equipment does not have to drain resources but can, in fact, generate positive operating revenue.

Analyzing Medicaid data from Kosair Children's Hospital in Louisville, Thai and his colleagues found that annual average costs of obtaining and using POCUS in the emergency setting total $75,240. The annual average revenue realized from the use of POCUS is $115,969, resulting in a net annual operating revenue of $40,729.

The researchers found that this net revenue can be realized using POCUS for four common pediatric procedures for which the device is indicated: examination after trauma injury, known as Focused Assessment for Sonography in Trauma or "FAST" exam; evaluation of abscesses; use of ultrasound for guidance in draining abscesses; and use of ultrasound for guidance in performing a femoral nerve block as a local anesthetic prior to surgery.

The group based their analysis on the perspective of physician fees, not facility reimbursement fees. "Facility reimbursement rates are not always consistent," Thai said. "This is another area of interest for our team, and we are already working on it in another multi-center study."

"It's highly unusual for a medical student to be presenting a platform presentation," Kim said. "Approximately 90 abstracts are submitted to the section of pediatric emergency medicine each year, and only 14 are accepted for platform presentation. It's a great honor for a faculty member or fellow to be accepted at the platform level. I can't remember seeing a medical student on the platform in the past 15 years, and I don't think a medical student has ever presented who is leading a multi-center collaboration."

Combining business with medicine

Thai -- who also is a second lieutenant in the U.S. Air Force -- is enrolled in the UofL School of Medicine's Distinction Track in Business and Leadership. Directed by Kim and Brad Sutton, M.D., the Distinction Track in Business and Leadership prepares medical students with a vital set of economic and business skills along with their medical education, integrating business instruction with the medical curriculum throughout the four years of medical school.

"Health care is a complex and dynamic field with many stakeholders and much uncertainty. Now, more than ever, health systems and providers are realigning with a renewed focus on cost reduction and improved outcomes," said Sutton, who is assistant professor of medicine and assistant dean for health strategy and innovation and holds an MBA degree from the Carey School of Business at Johns Hopkins University. "What's more, health providers are increasingly held accountable for outcomes and processes that are only partly in their control."

"Historically, formal business training at the medical student level was lacking, leaving new medical school graduates ill-equipped to address the economic challenges of practicing medicine today," said Kim, who also holds an MBA degree from UofL. "The UofL Distinction Track in Business and Leadership answers this need by providing a fundamental knowledge base that explores the intersection of business and medicine, and arms trainees with a vital skill set to succeed in our health economy."