Bedside Sonography in Emergency Departments in Turkey

Emergency departments in Turkey have been steadily improving their services since emergency medicine began as a specialty over 12 years ago, but bedside ultrasound (US) has not been implemented widely. In order to learn the extent of ultrasound usage and training opportunities, a 27-question survey was distributed to emergency medicine-trained physicians working in emergency departments at ten university hospitals (the busiest one in each geographical region, plus three others), which are referral centres covering over half of the country's population. Eight of the ten EM departments had an ultrasound machine in their ED (for a mean of 3.7 years), but the machines were used and controlled by the Department of EM in only four of the centres. While EM physicians knew how to perform US in seven centres, they routinely performed US themselves in only five. Of the 173 EM staff in the centres surveyed, 57 performed bedside US, and 28 possessed an US course certificate. All respondents wanted their EM residents to have formal US training, but such a rotation was present in only five centres. Bedside US was being performed in the following clinical situations: trauma (n=7), abdominal pain (n=7), renal colic (n=5), chest pain (n=3), assist to invasive procedures (n=3), locating subcutaneous foreign bodies (n=3), and dyspnea (n=1). Five departments had no form or system for documenting their US findings, and if finding anything suspicious, always sent the patients to radiology to have the US repeated. The mean duration from request-to-radiology-for-US to report-in-EM-physician's-hands was 47 minutes. Bedside US is performed by EM physicians in only half of the academic centers we surveyed. Documentation is absent in many, thus the quality or impact of this practice would be difficult, if not impossible, to determine. Formal educational programs are desired by all, but have yet to be implemented in half of the centres. Given the many benefits to patients of bedside US, diligent efforts still need to be made to improve this service in academic emergency departments in Turkey.