title: Economic impact of additional radiographic studies after registered diagnostic medical sonographer (RDMS)-certified emergency physician-performed identification of cholecystitis by ultrasound.
abstract: BACKGROUND
  The standard evaluation of patients with right upper quadrant (RUQ) abdominal pain consists of a history and physical examination, laboratory analysis, and radiological investigation. Given the increasing availability of bedside ultrasound in the Emergency Department (ED), a growing proportion of Emergency Physicians are now performing their own ultrasound examinations in patients with RUQ abdominal pain to circumvent diagnostic delays and improve patient care.
  
  
  OBJECTIVE
  To determine the economic "opportunity" costs of additional radiographic testing after identification of acute cholecystitis by focused ED ultrasound performed by registered diagnostic medical sonographer (RDMS)-certified personnel.
  
  
  METHODS
  A retrospective analysis of a consecutive sample of patients with "positive" focused ED ultrasounds of the RUQ that were significant for cholecystitis, who presented from June 1, 2005 through February 30, 2006. Cost analysis was performed using standard Medicare compensation indices for radiological examinations of the abdomen/hepatobiliary system.
  
  
  RESULTS
  There were 37 patients enrolled; 32 patients exhibited RUQ pain with a focused ED ultrasound significant for cholecystitis. Eight (25%) patients received no further radiographic tests and exhibited positive pathology. Twenty-four (75%) patients had additional diagnostic examinations; 22 (92%) showed positive pathology. Based upon Medicare compensation indices, an opportunity cost of $6885.34 was incurred at our institution over 9 months due to additional examinations. Using nationally comparable indices, this was extrapolated to an opportunity cost of $63 million (95% confidence interval $48.3-$78.9 million) per year across the nation, assuming that 50% of patients with cholecystitis present to the ED and receive an ultrasound examination by an RDMS-certified Emergency Physician.
  
  
  CONCLUSIONS
  In this small sample, additional radiological testing after ED ultrasounds significant for acute cholecystitis led to sizable economic costs on a local and national level. Formal cost-benefit analyses are needed to evaluate the full economic and patient care implications of ED ultrasound use in this setting.
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York 11030, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Young
authors.forename: Stephen
authors.initials: S
authors.lastname: Kinsella
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Raio
authors.forename: Matthew
authors.initials: M
authors.lastname: Nelson
authors.forename: Gerardo
authors.initials: G
authors.lastname: Chiricolo
authors.forename: Ashley
authors.initials: A
authors.lastname: Johnson
authors.forename: George
authors.initials: G
authors.lastname: Malcolm
authors.forename: Byron C
authors.initials: BC
authors.lastname: Drumheller
authors.forename: Mary Frances
authors.initials: MF
authors.lastname: Ward
authors.forename: Andrew
authors.initials: A
authors.lastname: Sama
mesh_terms: D000068:Accreditation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D041881:Cholecystitis, Acute / Q000000981:diagnostic imaging*; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D019095:Point-of-Care Systems / Q000191:economics*; D011859:Radiography; D012189:Retrospective Studies; D014463:Ultrasonography / Q000592:standards