title: Use of portable ultrasound machine for outpatient orthopedic diagnosis: an implementation study.
abstract: BACKGROUND
  Ultrasonography and magnetic resonance imaging (MRI) are used to evaluate shoulder disorders. This implementation study investigated outpatient ultrasonography at an orthopedic practice in a managed care setting.
  
  
  METHODS
  A portable ultrasound machine was introduced at an orthopedic clinic in a group practice. An orthopedic surgeon who primarily treated shoulder disorders received 15 hours of training. The impact of physician-performed ultrasonography on subsequent MRI and other outcomes of patients with shoulder disorders from January 2011 through October 2011 was determined using automated administrative and clinical data. Comparisons were made to patients who did not undergo ultrasonography at the experimental practice and 2 orthopedic clinics in the same practice.
  
  
  RESULTS
  During the study, 146 ultrasound examinations were administered. Compared with patients who did not undergo ultrasonography, patients who received ultrasonography had significantly higher comorbidity. However, they were significantly less likely to have MRI (9.7% with ultrasonography vs 14.4% without; p = 0.03) although equally likely to undergo surgery (33.6% with ultrasonography vs 22.1% without, p = 0.77). Mean time to surgery was 89.3 ± 49.3 days for patients with ultrasonography vs 32.9 ± 43.3 days for patients without (p < 0.05). No ultrasonography-examined patients had an incorrect diagnosis at surgery. For patients receiving ultrasonography, an estimated 35 MRIs were avoided, saving a predicted $17,603, a 50% return in less than 1 year on a $34,897 investment for an ultrasound machine and supplies.
  
  
  CONCLUSIONS
  Outpatient ultrasonography by an orthopedic surgeon can be useful for diagnosing shoulder disorders and might reduce MRI utilization.
authors.affiliation: Orthopedic Surgeon with Group Health Cooperative in Seattle, WA. E-mail: adelman.s@ghc.org.
authors.forename: Sean
authors.initials: S
authors.lastname: Adelman
authors.forename: Paul
authors.initials: P
authors.lastname: Fishman
mesh_terms: D000368:Aged; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D009985:Orthopedics / Q000191:economics; D010045:Outpatients; D017006:Rotator Cuff / Q000601:surgery; D012782:Shoulder / Q000000981:diagnostic imaging* / Q000601:surgery; D014463:Ultrasonography / Q000191:economics / Q000295:instrumentation / Q000706:statistics & numerical data*