PURPOSE:

POLICY:

PROCEDURE:

• Radiology is staffed by ultrasound technologists during the following hours:
• Monday-Friday 8a – 7pm (last scan 6pm)
• Saturday and Sunday  11a – 7p (last scan 6pm)

• Ultrasounds may be ordered for gynecologic emergencies and will be interpreted by radiologist on duty or on call through normal EPIC order process and reading procedure.
• During hours when an ultrasound technologist is not in house, radiology residents will scan these patients.

• Requested exams through EPIC will also need a direct call to the radiology resident.
• However, if an issue arises from a request to do a scan by a radiology resident that cannot be easily resolved between the provider who ordered the scan and the radiology resident, then a discussion should be escalated to the attendings of the respective services (ED, Radiology, and/or Ob/Gyn) currently involved in the care.  If the clinical case warrants, the escalated discussion can include attendings from all three services (ED, Ob/Gyn and Radiology).  
• All sonograms performed by the radiology resident will be read by the radiology attending on duty or on call through normal EPIC order process and reading procedure.

• Indications for emergency ultrasound include but not limited to the evaluation and work up of:

• Severe undifferentiated pelvic pain
• Pregnancy of unknown location
• Bleeding in the first trimester
• Severe abnormal uterine bleeding

This is to add in the diagnostic work up of possible gynecologic emergent diagnoses such as ectopic pregnancy, ovarian torsion, tubo –ovarian abscess, etc.

• If the radiology resident is not available for conducting the study emergently due to other emergencies and duties or if the radiology resident is not qualified to perform the ultrasound examination, the Emergency Medicine attending and GYN attending will determine the next steps in the care of this patient.

• The Emergency Medicine Attending will be the lead in the triage of the need of the ultrasound in relation to other emergent radiologic procedures that are needed in the ED.
• When patient transfer is required, Emergency Medicine and GYN will coordinate transport through MSHS transfer service.

QUALITY ASSURANCE:

All Ob/Gyn ultrasounds performed by the Radiology resident during hours ultrasound technologist is not available will be reviewed by MSHS telemedicine, Radiology, Ob/Gyn, and Emergency Medicine for compliance with policy for indications.

1. 4 pelvic probes will be put into room 5 at SL (the room left open for ultrasounds) by Pam the late tech before she leaves 
2. Cleaning will be handled the same way as at BI, dirty probes should be wiped and placed into a red biohazard bag, along with the patients written MRN on paper.  The bag should then placed in the trophon room.  
3. The trophon machine is the same at BI, and can be used if there are more than 4 pelvic ultrasounds are requested during evening hours.
4. The code for the trophon room is 1+3 (press together), then 2
5. If the resident on call is too busy with reading cross sectional studies, the pelvic cases may be delayed and thus you can suggest to the ED that they may need to transfer the patient to a different facility or wait for a next day ultrasound by the sonographer, at their discretion 

Further details regarding the cleaning procedure at BI (similiar procedure should be used at SL)

After using trophon probe with the plastic covering

1. remove plastic covering
2. wipe probe with sterile wipe to remove all ultrasound gel
3. place probe in red biohazard bag
4. place patient MRN written on paper into the same biohazard bag
5. move probe to room with trophon machine