ULTRASOUND
Navigating Medicolegal Risks in Point-ofCare Ultrasound: Strategies for Mitigation
SAEM PULSE | MAY-JUNE 2024
By Jacqueline Gomberg, MD, on behalf of the SAEM Academy of Emergency Ultrasound
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Point-of-Care Ultrasound (POCUS) has revolutionized emergency medicine (EM). At the bedside, we can now instantaneously diagnose the etiologies of shock, perform diagnostic imaging, and guide our procedures in real-time, all enhancing patient care. While the benefits of POCUS are numerous, many providers remain hesitant to adopt it due to concerns about increased litigation risks. With over 75% of EM physicians facing medical malpractice cases in their lifetime, the question arises: does performing POCUS increase one’s risk of being sued?
What is the medicolegal risk of POCUS? Medicolegal risk is the potential legal liabilities and consequences associated with providing medical care and services. It encompasses situations where medical decisions or actions
result in harm to patients and lead to litigation. Regarding POCUS, these risks include inadequate image acquisition, misinterpretation of findings, failure to perform indicated scans, and scope of practice issues. Much of what we know about the risk of using POCUS comes from retrospective analyses of medical malpractice cases. Through legal databases, several studies have analyzed the available public cases involving emergency medicine physicians and POCUS. An initial study performed by Blaivas et al., searched Westlaw, a legal database, for cases in the United States involving emergency medicine physicians and ultrasound between 1987-2007. While 659 medical malpractice cases met their initial search criteria, there were zero cases involving EM physicians incorrectly performing or interpreting an ultrasound.
A subsequent study performed between 2008-2012 by Stolz et al. utilized the same database and identified 120 potential medical malpractice cases between 2008-2012, with five cases where the physician was accused of misconduct in the emergency department (ED), and the interpretation or failure to perform an ultrasound that was within the ACEP (American College of Emergency Physicians) core applications was discussed. Of these five cases, three involved the ED physician not performing an ultrasound study, while the other two involved radiologyperformed ultrasounds. There were no cases involving misinterpretation or missed diagnosis by an emergency physician performing POCUS. A more recent analysis by Russ et al. between 2012 and 2021 similarly revealed no lawsuits involving misinterpretation or