Making the financial case for a surgeon-directed critical care ultrasound program.
BACKGROUND
We sought to demonstrate that a well-staffed, surgeon-directed, critical care ultrasound program (CCUP) is financially sustainable and provides administrative and educational support for point-of-care ultrasound.


METHODS
The CCUP provides a clinical service and training as well as conducts research. Initial costs, annual costs (C), revenue (R), and savings (S) were prospectively recorded. Using data from the first 3 years, we calculated the projected C, R, and S at 5 years. We determined CCUP sustainability by C < R and C < R + S at 3 years and 5 years.


RESULTS
During 36 months, the CCUP covered four surgical intensive care units (55 beds). Start-up costs included one basic and one cardiovascular device per 25 beds and a data storage system linking reports and images to the electronic medical record ($203,650). Billing increased threefold from Years 1 to 3, with a 21% increase between Years 2 to 3. Yearly costs included 0.5 full-time equivalent (FTE) sonographer and 0.2 FTE surgeon ($106,025); this was increased to 1 FTE and 0.25 FTE, respectively, for Years 4 and 5. The total 3-year cost was $521,725 and projected to be $863,325 by Year 5. The total 3-year revenue was $290,775 and projected to be $891,600 at 5 years. The total 3-year savings associated with the CCUP was $600,035 and is projected to be $1,194,220. With the use of the C < R, the CCUP meets operating expenses at Year 3 and covers overall cost at 5 years. If savings are included, then the CCUP is sustainable by its third year and is potentially profitable by Year 5.


CONCLUSIONS
A surgeon-directed CCUP is financially sustainable, addresses administrative issues, and provides valuable training in point-of-care ultrasound.
From the Division of Trauma and Surgical Critical Care (S.B.M., M.L., M.F., S.H.F., T.M.S.), Department of Surgery, University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, Baltimore, Maryland; and Department of Surgery (H.L.F.), University of Southern California, Los Angeles, California.
Sarah B
SB
Murthi
Heidi L
HL
Frankel
Mayur
M
Narayan
Matthew
M
Lissauer
Mary
M
Furgusen
Syeda H
SH
Fatima
Thomas M
TM
Scalea
D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000458:organization & administration*; D015150:Echocardiography, Doppler / Q000191:economics; D005260:Female; D019538:Health Care Surveys; D017721:Hospital Costs; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D010819:Physician's Role; D019095:Point-of-Care Systems / Q000191:economics* / Q000458:organization & administration; D015397:Program Evaluation; D018608:Ultrasonography, Doppler / Q000191:economics*; D014481:United States