Transvaginal ultrasonography by emergency physicians decreases patient time in the emergency department

Abstract

Objectives: An important argument for emergency physician use of ultrasonography is that it results in more rapid patient disposition, but there are few articles to support this position. This study sought to demonstrate a significant decrease in the time spent in the ED when emergency physicians performed transvaginal ultrasonography (TVUS), as compared with when TVUS was performed by consultants, in the evaluation of first-trimester pelvic pain or vaginal bleeding.

Methods: A retrospective analysis was conducted of the time spent in the ED (time placed in gynecologic examination room to time released from ED) by patients with first-trimester pelvic pain or vaginal bleeding necessitating further evaluation with TVUS. TVUS was performed in the ED by obstetrics/gynecology (ob/gyn) residents who were consulted to the ED from January 11, 1996, to March 31, 1996, and by emergency physicians from April 17, 1996, to July 7, 1996.

Results: Emergency physicians evaluated 46 patients by TVUS, with a mean time of 164.70 minutes (SEM +/- 13.29). Ob/gyn consultants evaluated 38 patients by TVUS, with a mean time of 234.79 minutes (SEM +/- 12.74). This was a significant difference at the level of p < 0.0003 (Student's t-test). There were no known missed ectopic pregnancies as ascertained by 100% patient follow-up. There was no significant difference between the groups in the percentage of ectopic pregnancies (Fisher's exact test). The number of patients in the emergency physician group requiring subsequent consultation was reduced by 85%.

Conclusions: This study demonstrates a more rapid ED transit time when TVUS was performed at the bedside by emergency physicians as compared with when pelvic ultrasonography required consultation. Additionally, fewer calls to consultants were required.