Common QA Issues
Please use a separate procedure note for your ultrasound procedures. This helps the coders identify the procedures.
Delayed note completion is an ongoing issue. Opening a procedure note when the order is placed will help to ensure that you do not forget. Otherwise, expect multiple emails if you forget the note.
Please use m-mode for fetal heart rate when doing pelvic ultrasounds. There is a theoretical risk of heating tissue with prolonged exposure to PWD. This is especially important in the first trimester. M-mode is post processing and does not involve any additional energy transmission to the tissue. If you do not know how to use m-mode, feel free to contact me.
Vascular access images do not require an image of the needle or catheter in the vessel. An image of the vessel is all that is needed.
Make sure that you document what you scan. For example, if you do a limited echo and then scan the lungs for B-lines, you should document limited echo and limited chest.
All resident scans need attending documentation for supervision. The documentation can be included with the resident supervision note under procedures. You can also use the following note below as a quick note.
ED Resident Ultrasound Supervision Note
I have reviewed and interpreted the ultrasound images and agree with the documentation of the resident physician.