First, there was “Failure to Perform”, then the next hot legal topic, “Failure to Perform in A Timely Manner,” took stage. We are in an age where there is a “Golden Hour” for everything – time to antibiotics, time to lysis, time to cath lab – and if you have been lucky enough to attend the ACEP Scientific Assembly over the last few years, you’ve likely heard that the legal landscape is changing to reflect this. Legal teams are now privy to the fact that ultrasound training is now mandatory in EM residencies, and we are beginning to see legal outcomes in which POCUS has played a role – though its legal role probably is not what you think.
Like many community ED docs, you are probably uncomfortable doing POCUS. Perhaps you don’t have the fancy machine you did in residency. Perhaps you are concerned it increases your liability, and you wonder why you would do it when radiology has a better machine and your institute has radiologists to share the wealth (and the lawsuits!).
First, one previous paper exists examining the liability of point of care ultrasound (POCUS). Admittedly, this was a 2012 paper looking at 1987-2007, and I would think POCUS has grown exponentially since that time. Regardless, of the 659 available POCUS cases examined, none were related to misinterpretation- but there was one was for failure to perform POCUS! Now a second study looks at the Westlaw database reviewing cases from January 2008 to December 2012 involving EPs and POCUS. Here they are:
Five cases in four years when POCUS is starting to take off. Without playing armchair quarterback too much, I’ll simply state that one of the central issues was that POCUS was *not* performed in all of the above cases. There were two other cases in which POCUS was not performed (intra-ocular foreign body after multiple beestings; dyspnea in a patient ultimately found to have acute mitral valve insufficiency on ECHO), but the counterargument was that these indications (intra-ocular FB, valvular evaluation) were not part of ACEP core applications & thus outside of the EPs scope. So what are ACEP’s Core Applications for Ultrasound? Trauma, IUP, AAA, cardiac, biliary, urinary tract, DVT, soft tissue/musculoskeletal, thoracic, ocular, and procedural guidance. That’s quite the range, and for a more detailed explanation, ACEP’s clinical policy on sono can be found here (opens pdf, specifics start around page 20)
There you have it. The precedent has been set. The failure to do POCUS for one of ACEP’s Core Applications in a timely fashion actually puts you at more risk then if you had performed POCUS. There has yet to be a case on public record to dispute this. POCUS. Learn it. Use it.