Ultrasound isn't just for pregnant women anymore. The portable device, best known for giving expectant parents their first glimpse of their babies in utero, is now being introduced as a tool in critical care. And Dr. Elizabeth Turner is helping lead the charge. Turner, UCLA director of bedside ultrasound in the Division of Pulmonary and Critical Care Medicine, is bringing the device to patients' bedside. She received a grant from the UC Center for Health Quality and Innovation to develop a curriculum to train doctors on how to use bedside ultrasound.
"This is quality improvement for patient care," said Turner, who began the project while at UC Irvine, where she was an assistant professor. "You can get the right therapy to the patient early. You can make the decision appropriately. Their outcomes are going to be better. There are direct cost savings. And patient satisfaction will improve if we can implement this as part of our practice." Bedside ultrasound involves portable ultrasound exams - using sound waves to see inside the body - that are performed and interpreted by the physician at the point of care. Turner emphasizes that ultrasound is not meant to replace the work of cardiologists or radiologists. Instead, it's about trying to identify quickly the appropriate test from the appropriate person.
"We're not trying to take anyone's business," Turner said. "We're just trying to give the business to the right person." A former ballet dancer, Turner got a late start in medicine, applying to medical school at age 25. With a dancer's focus and dedication, she leaped forward as a physician, following medical school at Wake Forest University with a residency at UC San Francisco and a critical care fellowship at Stanford University, where she first received training in ultrasound.
"It just made so much sense, especially in critical care where minutes make a big difference in a patient's life," Turner said. "I realized what a powerful tool it was and got excited about it." It's estimated that for every $1 spent on ultrasound, a total of $3 is saved in patient care. For example, the typical legal settlement on a collapsed lung is about $150,000, but using ultrasound dramatically reduces the risk of a patient suffering that problem. "One lawsuit will pay for three ultrasound machines," Turner said. But standardized training in point-of-care ultrasonography is lacking. Enter Turner's innovation center project.
She tested her training (which combined e-learning and hands-on supervision) on critical care and cardiology fellows at UC Irvine. It turned out to be a quick and efficient method - the fellows gained knowledge and confidence equal or superior to that of experts and apprentice-based learners. And they did so in less than four months, compared with other training pathways that can take two to four years. Under Turner's direction, UC Irvine increased its use of bedside ultrasound; a preliminary assessment of trends shows that length of stay in the intensive care unit has declined by approximately a day while patient satisfaction has improved. "They like that the doctors are hands-on," Turner said. "Hands-on means we're at the bedside scanning them."
Turner now is working to expand bedside ultrasound at UCLA and hopes to scale up training to spread its use systemwide. Also, she has had abstracts about the project accepted for two national conventions. "The national societies feel this is a relevant topic," Turner said. "Bedside ultrasound is here to stay. We need to do it properly." One afternoon, Turner gave a team of UC Irvine residents an hour-long training session on using bedside ultrasound to look at the heart. That night, one of those residents used the machine to examine a patient with low blood pressure and found a huge sac of fluid around the heart. "If he hadn't picked that up, the patient could have died," Turner said. "That was after a one-hour lesson. Imagine what you could do after an organized program."