Upstate University Hospital Emergency Departments using new portable ultrasounds

SYRACUSE — Upstate University Hospital is equipping its emergency departments (ED) with new portable machines that will allow staff to “better diagnose and treat patients.” The new MindRay TE X portable ultrasound machines feature better images, the ability to make calculations health-care professionals previously had to do manually, an interface with patient records in EPIC, and an artificial-intelligence component used strictly for educational purposes, Upstate Medical University said in its online announcement. The downtown ED has two new machines, and “plans are in the works” for Upstate Community Hospital and the pediatric EDs to get new ones as well, Upstate Medical noted. Dr. Matthew Camara, assistant professor of emergency medicine (EM), said previous machines used in the downtown, Community, and pediatric emergency departments are “out of date.” “We wanted to have machines that not only the residents and faculty could use to perform bedside ultrasound but that had the functionality and the capabilities to really bring point of care ultrasound to the next level,” said Camara, who is also the assistant residency program director of emergency medicine. Portable ultrasound machines have been a “mainstay” in the emergency department for more than 30 years, Upstate Medical said. They were first used on trauma patients, but since then, their usage has expanded to help diagnose everything from an injured tendon to abdominal pain to shortness of breath. Now, they’re in use round-the-clock, on average 20 times in a 24-hour period, Canara said. As the technology has evolved, so too has the use of the machines. “Anyone with chest pain, anyone with shortness of breath, anyone that has concern for a kidney stone, gallstone, those are all bedside ultrasounds,” he said. “Abdominal pain from kidney stones, pneumonia, congestive heart failure, cellulitis, are all diagnosis that can be made with ultrasound to name a few. We use the ultrasounds during procedures to increase patient safety and decrease the risk of complications.”

Ultrasound usage

Emergency-medicine physicians who have trained at an EM residency, or who are board certified in EM, are able to perform ultrasounds without a special certification since ultrasound training is part of the required curriculum, Upstate Medical said. Resident physicians can also perform an ultrasound but need attending oversight in real time or with image review for educational studies. Advanced-practice practitioners can also perform bedside ultrasound with attending oversight, or independently, if they have demonstrated expertise on par with EM residency-trained physicians. A provider rolls the ultrasound machine to the bedside, enters the patient information, and performs the ultrasound exam. The provider goes onto the web-based middleware (Butterfly Inc.) and signs the study, which then then transfers the images and report to the patient chart, Upstate said. The new machines, which were rolled out back in July, offer a “much sharper and clearer” image than the old machines, allowing doctors to detect smaller, more nuanced findings, Camara said. For example, on a FAST (Focused Assessment with Sonography in Trauma) exam for a trauma patient which evaluates spaces where free fluid can accumulate, the improved image makes it easier to identify that free fluid, for example in a case of intra-abdominal bleeding. “The improved image quality allows us to see smaller details, which improves earlier recognition of pathologic processes at the bedside,” he said. The machine also allows for “more comprehensive” cardiac exams by measuring volumes and velocities — elements doctors previously had to do manually — and it provides a look at diastolic heart function, something the previous ultrasounds “could not reliably perform.” The new machines also upload images to a patient’s digital chart, allowing other doctors to review them in real time, and thereby improving the ED’s workflow, Camara noted. At the same time, the machines include an artificial intelligence (AI) function used for teaching purposes. The machines have built-in reference images that residents can pull up for help. Camara said if a resident is looking at the heart for example, but the image is missing a chamber, the machine can show them they are not getting the right view so they can adjust. Camara stressed the AI is “purely for educational purposes at this time.”