UW MEDICINE ULTRASOUND

Harborview After-Hours Ultrasound

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Routine coverage hours for emergency department ultrasound examinations are 7am to 10pm every day, including weekends and holidays, and includes all studies ordered before 10pm.

Routine coverage hours for inpatient ultrasound examinations are 7am to 7pm every day, including weekends and holidays.  (Non-emergent studies will be read during normal working hours).

Radiology has a sonographer on site from 7am to 730pm seven days a week. They perform studies ordered by 7pm which can be completed by 730pm. Appropriate studies that cannot be completed by 730pm will be performed by the on-call sonographer, with rare exceptions for critical patients. There is a sonographer on call from 7pm to 7am seven days a week.

Radiology faculty and trainees are the only ones authorized to call in the sonographer on call.  They are responsible for making sure that all cases meet the coverage hours or indication criteria before calling the sonographer. For all studies at all times, they should review the indications to ensure that the US study requested is the appropriate imaging study (rather than another modality such as CT). For studies ordered outside of routine coverage hours, they should also ensure that the appropriate criteria for an after hours study has been met (e.g. patient has a positive beta hcg, if a pelvic US to rule out ectopic pregnancy is ordered).  For studies that do not meet criteria, please see [1]

The procedure for calling in the sonographer on call is as follows.

  1. Page the sonographer on call through the operator.
  2. If no response in 5 minutes, page again (in case the first page did not go through).
  3. If no response in 15 minutes (from the 2nd page), page the on call Radiology Supervisor, through the operator. They will find someone to come in.
  4. Do not page the sonographer or supervisor directly, as use of the operator creates a record of pages placed. Only if there is no response after paging the sonographer and supervisor through the operators, should you page the supervisor (206-540-5719) or sonographer (206-541-6498) directly.
  5. The exam should be started within an hour after contacting the sonographer, unless other more urgent exams are performed first, or other arrangements have been explicitly made with the radiologist.

Please refer any questions or problems after hours to the on-call Radiology Supervisor .

 

[1] For ED and inpatient/outpatient US, see below

If an ED US is requested after hours that does not meet criteria, it must be requested by the ED attending on service. ERad resident/fellow will contact the ERad attending on call and provide them with the requesting attending’s name and phone/pager number where they can be reached. ERad attending contacts requesting attending & decides if study will be performed.

If an inpatient or outpatient US is requested after hours that does not meet criteria, the requesting team will be instructed to page the Body Imaging Fellow on call and discuss the case with them.

Following these communications, the ERad attending or Body Imaging Fellow contacts ERad resident/fellow to inform them if study is approved or cancelled.

If study is approved, ERad resident/fellow contacts sonographer and informs them that study was approved by ERad attending or Body Imaging fellow, and the sonographer comes in to perform the study.

If sonographer feels that study is inappropriate, they still come in and perform study, but will document their concerns with US supervisor. If US supervisor agrees that study was inappropriate, it can be addressed directly with radiologist involved or brought to CSIC US for further discussion.

 Criteria for obtaining an Ultrasound after routine coverage hours

  • Suspected ectopic in a woman with vaginal bleeding and/or pelvic pain with a positive β-hCG (serum or urine), regardless of how low it may be.
  • Pelvic U/S to evaluate for retained products of conception.
  • Suspected ovarian torsion.
  • Pregnant patients with abdominal pain, vaginal bleeding, trauma (if further evaluation of the placenta or fetus is required beyond documentation of heart rate).
  • Sudden onset testicular pain to evaluate for torsion.
  • Trauma to the scrotum to evaluate for rupture.
  • RUQ pain with elevated WBC to evaluate for cholecystitis.
  • Abdominal pain: Newly elevated or rising WBC.
  • Pelvic pain: Newly elevated or rising WBC.
  • Mark for paracentesis: Newly elevated or rising WBC.
  • Mark for thoracentesis: Newly elevated or rising WBC.
  • Suspected TIPS Shunt malfunction: (Note that imaging within 24-48 hours of placement of a covered stent will likely not permit direct visualization of flow within the stent).
  • Acute liver failure: No prior imaging to indicate etiology.

NOTE: Immunocompromised patients with the above findings may be imaged emergently if requested by the clinical team, even if there is no elevated WBC.

Unforeseen exceptions to these guidelines may occur. If there is a question or concern that cannot be resolved by the radiology resident, then the ERad attending or Body Imaging fellow should be contacted, and they may override the guidelines and call in the sonographer.

This document was created for, and collected and maintained by a quality improvement program or committee and is not subject to discovery or introduction into evidence in any civil action. See RCW 70.41.200, RCW 4.24.250, RCW 43.70.510 and RCW 70.168.0.0.

3/19/14: Version 1-19. Approved by Eddie Oliver, David Green, Manjiri Dighe & Joel Gross.

11/19/2012. Version 1-14. Approved by Eddie Oliver, David Green, Manjiri Dighe & Joel Gross.

10/5/11. Version 1-12. Approved by Stephanie Pardee, David Green, Manjiri Dighe and Joel Gross.