title: Current status of emergency department attending physician ultrasound credentialing and quality assurance in the United States.
abstract: BACKGROUND
  The use of emergency ultrasonography (EUS) has gained much popularity in the past few decades, and is now a mainstay of diagnostic decision-making. This expanded use is now highlighting the substantial issue of individual hospitals in credentialing its emergency medicine attending physicians in EUS in the United States. This issue is also of importance as more hospitals are now requesting reimbursements for emergency ultrasounds. The objective of this study is to gain an understanding of how many emergency departments are currently credentialing its attending staff in EUS, what the internal structure and staffing are of these emergency departments, and how they are currently performing quality assurance of the ultrasounds performed.
  
  
  METHODS
  This was a cross-sectional, web-based survey sent to 160 ACGME-accredited EM residency programs from July 2013 to November 2013. The survey consisted of 23 questions regarding: (1) number of emergency medicine attendings on staff, (2) presence of an EUS fellowship, (3) quality assurance (QA) process, and (4) current US credentialing process.
  
  
  RESULTS
  There was a 50 % response rate. Fifty percent of the total respondents (n = 40) had an EUS fellowship program. Of the sites with an EUS fellowship, 36 had EUS fellowship-trained attendings. Of the sites without an EUS fellowship, 19 had EUS fellowship-trained faculty, p ≤ 0.0001. Sites with an EUS fellowship had a greater percentage of staff credentialed to perform EUS as compared to sites with no EUS fellowship, p = 0.0161. All sites with an EUS fellowship had EUS-credentialed attendings. In sites with an EUS fellowship, 35 conducted a formal QA of ED performed EUS scans versus 22 at sites without an EUS fellowship, p = 0.003.
  
  
  CONCLUSIONS
  The survey results support hiring emergency attendings that have completed postgraduate training in emergency ultrasonography to aid in credentialing staff. This also seems to be helpful in completing a timelier QA of all ED ultrasounds.
authors.affiliation: Department of Emergency Medicine, Northwell Health-Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY, 10305, USA. devdas2@gmail.com.
authors.forename: Devjani
authors.initials: D
authors.lastname: Das
authors.affiliation: Department of Emergency Medicine, Northwell Health-Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY, 10305, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Kapoor
authors.affiliation: Department of Emergency Medicine, Northwell Health-Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY, 10305, USA.
authors.forename: Cara
authors.initials: C
authors.lastname: Brown
authors.affiliation: Department of Emergency Medicine, Northwell Health-Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY, 10305, USA.
authors.forename: Afoma
authors.initials: A
authors.lastname: Ndubuisi
authors.affiliation: Department of Emergency Medicine, Northwell Health-Franklin Hospital, 900 Franklin Ave, Valley Stream, NY, 11580, USA.
authors.forename: Sanjey
authors.initials: S
authors.lastname: Gupta
keywords: Credentialing; Education; Emergency ultrasonography; Quality assurance; Survey