Logistics of perioperative diagnostic point-of-care ultrasound: nomenclature, scope of practice, training, credentialing/privileging, and billing.

Abstract

In modern health care, the performance of many bedside procedures and the evaluation of critically ill patients is facilitated by point-of-care ultrasound (PoCUS). PoCUS has unique and evolving value to each specialty. Thus, the chronology of adoption of PoCUS has varied significantly across specialties. For instance, anesthesiologists were early to adopt PoCUS for regional anesthesia, vascular access, and transesophageal echocardiography, but slow to integrate other PoCUS applications that were more rapidly adopted by acute care specialties such as critical care and emergency medicine. These latter 2 specialties have shown that PoCUS of the heart, lungs, abdomen, and/or lower extremity veins can be used to rapidly narrow the differential diagnosis of hypotension, respiratory failure, and other kinds of acute organ dysfunction. Since acute organ dysfunction management is also part of the routine work of anesthesiologists, it is not surprising that anesthesiologists are now trying to integrate more diagnostic PoCUS into their work. Furthermore, separate from acute organ dysfunction, diagnostic PoCUS has relevance to anesthesiologists in nonacute settings, such as the preoperative evaluation clinic where the ultrasound data can help with risk stratification and the evaluation of chronic symptoms. To use diagnostic PoCUS successfully, anesthesiologists will need to overcome, at minimum, the challenges that have historically hampered diagnostic PoCUS use in critical care and emergency medicine: variability in training and uncertainties in credentialing/privileging and billing. To address these challenges, anesthesiology departments will need to standardize training and work with hospital administrators to define locally appropriate credentialing/privileging and billing protocols. The following review offers a roadmap on how these things could be accomplished by drawing on both the experiences of other specialties and on guidance recently published by anesthesiology-specific professional medical organizations. Specifically, the review covers the following diagnostic PoCUS topics: (i) nomenclature; (ii) anesthesiology-relevant scope of practice; (iii) minimum level of training needed to achieve competence; (iv) credentialing/privileging; and (v) billing.