I can understand your dilema. However a way to better your condition would
be for your hospital to implement evidence based medical protocols for exam
work up. For instance before a venous study is sent to the Vascular Lab or
Radiology, D-dimer and other tests may be run, and considered with better
clinical assessment of the patient. The percentage of true clots will be higher
and over utilization will be lower.
Carotid ultrasound patients should have a CT versus a carotid ultrasound as
the STAT choice. The stroke is in the head, not the neck. Most CEA's are
not performed stat so the need for a CU STAT becomes less likely.
Pulmonary embolisms need to be diagnosed. A spiral CT will diagnose. If there
is no PE there is no need for the venous ultrasound. A lot of this is common
sense but there is a profitable money trail defining how medicine is practiced.
Suspected arterial graft occlusions could have angios to determine where or
how many places grafts are stenosed or occluded. If a patient is at risk of
losing their leg, no one should wait 30 to 45 min for a sonographer to drive in
and get the machine to the ER and crank it up for an ultrasound. The patient
should have an emergent angio procedure. We find that most clinical
assessments performed in the ER by MD's or PA's do not reflect understanding
of vascular pathology and they order everything in the book to CYA. Evidence
based medical protocols would help minimize willy nilly orders, especially in the
middle of the night.
Our hospital's Vascular Lab does not take call. Radiology is here 24/7 and will
not turn over the vascular testing (carotids and venous duplex) to the
Vascular Lab. Therefore, since they are here anyway, there is no need to
have two departments doing double duty. We backed away from call
successfully and Radiology is performing vascular exams after hours.
The only real STAT vascular exam that a Vascular Lab would perform is an
assessment for DVT, or a TCD in the case of an acute stroke confirmed with
CT. Unless your hospital is a certified Stroke Center with a team of trained
physicians and sonographers performing TCD's, there is no need for a vascular
or radiology ultrasound sonographer to come in STAT for a carotid ultrasound.
Some may disagree with this but Neurologists and research on the web
support this statement.
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