SBH Health System has taken the lead in the Bronx in implementing a point of care PACS (for Picture Archiving and Communications System) for its point-of-care ultrasounds in the emergency department.
Ultrasound is used routinely these days in hospital emergency departments. However the informatics portion employed since March at SBH is a game changer in that it allows electronic images and clinically relevant reports to be stored and transmitted digitally to providers anywhere in the world. It’s a capability typically found only in academic institutions. At SBH, the project took about two years to complete.
“Until now, we had been writing notes in the charts saying this is what we saw in the ultrasound,” says Dr. Jakub Bartnik, the director of ultrasound in the Department of Emergency Medicine at SBH. “Now, when a patient gets admitted or goes and follows up with another provider, a specialist for instance, the doctor knows exactly what we saw in the ultrasound.
“All the images go to PACS and any specialist can look and see exactly what was seen in the emergency department.”
SBH’s emergency medicine physicians have been using bedside ultrasound since 2013, and now have three mobile units that can easily be moved to patient bedsides as needed. It’s something that the department’s residents have been intensively trained in. In fact, says Dr. Jeffrey Lazar, vice chair and medical director of the emergency department at SBH, the residents are so well schooled in the technology that a “reverse curve” occurs, whereby older attendings who are not as well versed in ultrasound count on assistance from their residents.
Dr. Bartnik completed a fellowship in ultrasound after graduating from the SBH residency program and returning to the hospital last year. This has become a bit of a tradition at SBH (with Dr. Yash Chavda, a 2019 graduate becoming the fourth resident alumnus in as many years to spend a year in ultrasound fellowship training).
Ultrasound is used on a wide gamut of patients. It can explore the heart,
kidneys or gallbladders for flaws; check for abscesses in the skin, clots in the legs, or retinal detachments in the eyes. It can determine if a young woman who presents with severe abdominal or pelvic pain, and may not even realize she’s pregnant, is actually suffering from an ectopic pregnancy that must be treated promptly. Complex procedures such as pericardiocentesis, paracentesis, thoracostomy and detection of foreign bodies have been made much easier with ultrasound technology.
“We use it all the time,” says Dr. Bartnik. “One of the most useful things we do is echocardiograms to take a look at what the heart is doing. We diagnose patients with pulmonary embolisms where they can’t breathe and we don’t know why. The cause could be anything from asthma to heart failure, from a collapsed lung to a life-threatening embolism. There are obviously some physical exam findings that point us in one direction or another, but they are not always as super reliable as ultrasound.”
A key benefit of this technology, says Dr. Bartnik, is that it is rapid. “The sicker the patient, the more useful the modality is,” he says. “It’s become part of our physical exam. It’s so much easier to make a diagnosis with an ultrasound machine.”
In the case of a possible pulmonary embolism, for example, there may be no time to get to the patient to a catscan. “So, I have to make that diagnosis at bedside,” says Dr. Bartnik. “Some benefits of using ultrasound are timesaving, and some like these are lifesaving.”