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RE: [echocardiography] Re: ?standard procedure

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  • Hogan, Candy
    What a great response. I also agree with this. We do a complete draft report off of our digital reporting system and the physician reviews the images and
    Message 1 of 20 , Jul 30, 2004
      What a great response. I also agree with this. We do a complete draft report off of our digital reporting system and the physician reviews the images and report at the same time. This makes all of my Sonographers competent in what they do. They have learned so much by doing this. Our Cardiologist have so much respect for the Sonographers and they have more time to spend with their patients!

      Candy Hogan, RDCS
      Cardiology/Echocardiography/EEG Supervisor
      6001 Norris Canyon Rd.
      San Ramon, CA 94538
      candy.hogan@... <mailto:candy.hogan@...>
      925-275-8846 Direct line
      925-275-8287 Office
      925-275-8397 Fax



      -----Original Message-----
      From: Jack Colman [mailto:j.colman@...]
      Sent: Friday, July 30, 2004 6:51 AM
      To: echocardiography@yahoogroups.com
      Subject: RE: [echocardiography] Re: ?standard procedure


      I see it differently.

      I see the preliminary report, provided by the sonographer to the
      interpreting cardiologist, as the assessment of one trained professional
      as to the content of the study. The second trained professional, the
      cardiologist, reviews the study, and adds his own input into the
      findings, and his interpretation, using the findings of both reviewers.
      Extra eyes on the study are only helpful. Sometimes I see things the
      sonographer missed. Sometimes I review a study and realize I did not
      appreciate what the sonographer put in the preliminary report. Then I
      go back and look again. Often I find that I can agree, so I change the
      final report to take both sets of eyes into account. Sometimes I don't
      agree; then, I report it the way I see it. It's my report, and I'm "the
      cardiologist" = that is my professional responsibility. But I don't see
      the sonographer as "doing my work for me; rather s/;he is enhancing the
      quality of the product not only by producing the images, but by
      reporting his/her assessment of them. We are colleagues, not
      competitors. The final responsibility, legally and ethically, is the
      responsibility of the physician. That's our system; that's the nature
      of our training and our mandate. But we work as a team.

      Jack M. Colman MD, FRCPC
      <mailto: j.colman@...>
      Division of Cardiology, University of Toronto, at Mount Sinai Hospital,
      and
      Toronto Congenital Cardiac Centre for Adults at Toronto General
      Hospital/UHN
      600 University Avenue, Suite 1603
      Toronto, ON M5G 1X5
      416-586-5288 Fax 416-586-5968



      -----Original Message-----
      From: oldechodude [mailto:mwadams@...]
      Sent: July 29, 2004 7:53 PM
      To: echocardiography@yahoogroups.com
      Subject: [echocardiography] Re: ?standard procedure


      Thanks for this input, Sandy. I was suckered into preliminary
      reporting over 15 years ago, but I soon realized that some of the
      physicians were "rubber stamping" my technical notes and
      observations. I ceased putting anything other than measurements into
      writing. I am very pleased that we have guidelinelines, now, and
      hope that everyone will adopt these. It's not just a matter of
      law...it's a matter of patient care....

      Mike

      --- In echocardiography@yahoogroups.com, "Sandy Katanick"
      <katanick@i...> wrote:
      > I feel compelled to provide an ICAEL comment regarding preliminary
      reports.
      > The ICAEL actually has written standards that address the use of
      preliminary
      > reports in a clinical setting. The standards, taken from
      Organization
      > Section 3, read as follows:
      >
      > 3.2.2 Preliminary reports prepared by the physician should
      be completed
      > within 24 hours (verbal or written) with final reports completed
      within 48
      > hours. STAT reports should be available immediately, if
      possible. URGENT
      > reports should be available the same day.
      >
      > Note: Suggested method for reporting life-threatening findings:
      Optimally,
      > the interpreting physician in the laboratory will call the
      appropriate
      > physician. Alternatively, the sonographer will call the
      appropriate
      > physician after conferring with the interpreting physician.
      >
      > 3.2.3 If preliminary reports are issued, their preliminary nature
      should be
      > clearly indicated. Verified final reports should be provided
      within 48 hours
      > after the posting of preliminary results. A mechanism for
      communicating any
      > significant changes must be defined for those situations in which
      the final
      > interpretation differs substantially from the preliminary report.
      >
      > Note: Sonographer worksheets, comments, or other
      communication of findings
      > must not be issued as preliminary reports for the purpose of
      clinical
      > management.
      >
      > The ICAEL recognizes that sonographer preliminary reports or
      worksheets are
      > often relied upon by the interpreting physician when writing
      his/her final
      > report however the standards are very clear that they should not
      be issued
      > to referring physicians for the purpose of clinical management.
      To view all
      > of the ICAEL Standards please go to
      > http://www.intersocietal.org/icael/apply/standards.htm. Thanks
      Sandy
      >
      >
      > Sandra L. Katanick, CAE
      > Executive Director
      > Intersocietal Accreditation Commission
      > 8840 Stanford Boulevard, Suite 4900
      > Columbia, Maryland 21045
      > Phone: 410-872-0100 Fax: 410-872-0030
      > Web Sites: www.icavl.org; www.icael.org; www.icanl.org
      >
      >
      >
      > -----Original Message-----
      > From: Gerson Lichtenberg [mailto:gersonsl@s...]
      > Sent: Tuesday, July 27, 2004 11:16 PM
      > To: echocardiography@yahoogroups.com
      > Subject: Re: [echocardiography] ?standard procedure
      >
      >
      > This interesting discussion arises from time to time
      > in the field.
      >
      > Let me caution you about those who offer what sounds
      > like legal advice but are not lawyers. That should
      > make you nervous much as your own situation does. Your questions could

      > use a little clarification.
      >
      > 1) Are you talking about inserting the TEE probe
      > yourself, manipulating it, or simply operating the echocardiograph
      > while the anesthesiologist manages the probe? To put this in
      > perspective, TEEs were first done in the U.S. in the operating room,
      > with the anesthesiologists or gastro-enterologists teaching the
      > cardiologists to insert probes.
      >
      > 2) Are the Neonatologists taught to interpret
      > echocardiograms along with the echocardiographer? I
      > would expect them to have general expertise in
      > ultrasound and in fetal echocardiography. Or are you
      > just presenting them with a preliminary without
      > showing them the study?
      >
      > 3) Do you have any internal monitoring or education
      > process which attempts to get consistency in
      > preliminary reporting among the echocardiographers? Preliminary
      > reports are generally useless if the physician reports contradict them

      > later on.
      >
      > I won't give you advice on the preliminary reporting
      > issue, but my experience is that the ultrasound
      > community has never offered any support to the idea of
      > sonographers/echocardiographers providing reports to physicians other
      > than those doing the interpreting. The Scope of Practice that Nikki
      > mentions (available on the www.sdms.org site) is somewhat ambiguous. I
      > believe that the idea is that we can aid the physician
      > making the diagnosis.
      >
      > That being said, my own personal experience over a 25
      > year period is that preliminary reporting can be done
      > well under very controlled circumstances. I can't
      > promise that this is defensible legally, but your
      > situation is not unique.
      >
      > It is important to understand how the data from the echocardiogram is
      > used to make clinical decisions. If you understand the impact of what
      > you say, you can often provide the useful information without saying
      > all of the other findings that may be confusing or
      > irrelevant. Also, I sometimes say things in a way that
      > I know that a cardiologist would understand but that
      > the internist might find somewhat puzzling. This is
      > one of my ways of suggesting that they get a
      > cardiology consultation which will then increase the
      > speed with which the official echo interpretation will
      > get incorporated into the patient's medical care.
      >
      > Feel free to contact me directly if you have any
      > specific questions. Good luck!
      >
      > Gerson Lichtenberg, RDCS, APS
      > Cardiology
      > Rush Oak Park Hospital
      > Oak Park, Illinois
      >
      > --- Bob Hammler <echobob747@y...> wrote:
      > > I'm employed at a hospital that requires its
      > > echotechs to do some duties that I find questionable
      > > - is anyone else in this position?
      > > 1.Is it reasonable or legal to require echotechs
      > > to perform perioperative TEE's without
      > > a Cardiologist involved other than
      > > interpretation after the case is completed?
      > > 2.How about techs providing preliminary reports
      > > to Neonatologists with the Ped.
      > > Cardiologist interpretation available days or
      > > even weeks after treatment is given?
      > > 3.With Cardiologists becoming more and more
      > > scarce, we are increasingly being
      > > requested to provide preliminary reports to
      > > ordering physicians knowing that the
      > > the Cardiologist's interpretation will show up
      > > days after treatments are given?
      > >
      > > Am I being paranoid or am I being required to do
      > > things I shouldn't be doing?
      > > What resources are available to me?
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > > ---------------------------------
      > > Do you Yahoo!?
      > > New and Improved Yahoo! Mail - Send 10MB messages!
      >
      >
      >
      >
      > Yahoo! Groups Links




      Yahoo! Groups Links









      Yahoo! Groups Links
    • Elizabeth Maher
      I agree completely with Jack and this is how I work in Australia with the various Cardiology practices. The sonographers produce the preliminary report and the
      Message 2 of 20 , Jul 31, 2004
        I agree completely with Jack and this is how I work in Australia with
        the various Cardiology practices. The sonographers produce the
        preliminary report and the cardiologist reviews the study and the report
        and either changes the preliminary or agrees completely.We work
        together.

        Regards

        LM



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      • Brian Stockard
        There is a difference of preliminary report versus worksheet. I feel it a sonographer s duty to give the interpreter a worksheet with as much information and
        Message 3 of 20 , Jul 31, 2004
          There is a difference of preliminary report versus worksheet. I feel it a sonographer's duty to give the interpreter a worksheet with as much information and judgement they can. A preliminary report is available to others as well. If medical decisions is based on the sonographer's preliminary reports, then we have crossed a line in matters of printed Medicare regulations and physician billing. In the vascular world I expect a "rubber stamp", but even with my experience and confidence in echocardiography, that modality is so complex that I believe the only results that need to made available to the medical decision makers is a comprehensive final report. Much trouble will be averted this way. It is also imperative the final report is processed and made available in a reasonable amount of time.

          YIS (Yours in Sonography)
          Brian Stockard, BS, RCS, RVS

          -----Original Message-----
          From: Jack Colman <j.colman@...>
          Sent: Jul 30, 2004 9:50 AM
          To: echocardiography@yahoogroups.com
          Subject: RE: [echocardiography] Re: ?standard procedure

          I see it differently.

          I see the preliminary report, provided by the sonographer to the
          interpreting cardiologist, as the assessment of one trained professional
          as to the content of the study. The second trained professional, the
          cardiologist, reviews the study, and adds his own input into the
          findings, and his interpretation, using the findings of both reviewers.
          Extra eyes on the study are only helpful. Sometimes I see things the
          sonographer missed. Sometimes I review a study and realize I did not
          appreciate what the sonographer put in the preliminary report. Then I
          go back and look again. Often I find that I can agree, so I change the
          final report to take both sets of eyes into account. Sometimes I don't
          agree; then, I report it the way I see it. It's my report, and I'm "the
          cardiologist" = that is my professional responsibility. But I don't see
          the sonographer as "doing my work for me; rather s/;he is enhancing the
          quality of the product not only by producing the images, but by
          reporting his/her assessment of them. We are colleagues, not
          competitors. The final responsibility, legally and ethically, is the
          responsibility of the physician. That's our system; that's the nature
          of our training and our mandate. But we work as a team.

          Jack M. Colman MD, FRCPC
          <mailto: j.colman@...>
          Division of Cardiology, University of Toronto, at Mount Sinai Hospital,
          and
          Toronto Congenital Cardiac Centre for Adults at Toronto General
          Hospital/UHN
          600 University Avenue, Suite 1603
          Toronto, ON M5G 1X5
          416-586-5288 Fax 416-586-5968



          -----Original Message-----
          From: oldechodude [mailto:mwadams@...]
          Sent: July 29, 2004 7:53 PM
          To: echocardiography@yahoogroups.com
          Subject: [echocardiography] Re: ?standard procedure


          Thanks for this input, Sandy. I was suckered into preliminary
          reporting over 15 years ago, but I soon realized that some of the
          physicians were "rubber stamping" my technical notes and
          observations. I ceased putting anything other than measurements into
          writing. I am very pleased that we have guidelinelines, now, and
          hope that everyone will adopt these. It's not just a matter of
          law...it's a matter of patient care....

          Mike

          --- In echocardiography@yahoogroups.com, "Sandy Katanick"
          <katanick@i...> wrote:
          > I feel compelled to provide an ICAEL comment regarding preliminary
          reports.
          > The ICAEL actually has written standards that address the use of
          preliminary
          > reports in a clinical setting. The standards, taken from
          Organization
          > Section 3, read as follows:
          >
          > 3.2.2 Preliminary reports prepared by the physician should
          be completed
          > within 24 hours (verbal or written) with final reports completed
          within 48
          > hours. STAT reports should be available immediately, if
          possible. URGENT
          > reports should be available the same day.
          >
          > Note: Suggested method for reporting life-threatening findings:
          Optimally,
          > the interpreting physician in the laboratory will call the
          appropriate
          > physician. Alternatively, the sonographer will call the
          appropriate
          > physician after conferring with the interpreting physician.
          >
          > 3.2.3 If preliminary reports are issued, their preliminary nature
          should be
          > clearly indicated. Verified final reports should be provided
          within 48 hours
          > after the posting of preliminary results. A mechanism for
          communicating any
          > significant changes must be defined for those situations in which
          the final
          > interpretation differs substantially from the preliminary report.
          >
          > Note: Sonographer worksheets, comments, or other
          communication of findings
          > must not be issued as preliminary reports for the purpose of
          clinical
          > management.
          >
          > The ICAEL recognizes that sonographer preliminary reports or
          worksheets are
          > often relied upon by the interpreting physician when writing
          his/her final
          > report however the standards are very clear that they should not
          be issued
          > to referring physicians for the purpose of clinical management.
          To view all
          > of the ICAEL Standards please go to
          > http://www.intersocietal.org/icael/apply/standards.htm. Thanks
          Sandy
          >
          >
          > Sandra L. Katanick, CAE
          > Executive Director
          > Intersocietal Accreditation Commission
          > 8840 Stanford Boulevard, Suite 4900
          > Columbia, Maryland 21045
          > Phone: 410-872-0100 Fax: 410-872-0030
          > Web Sites: www.icavl.org; www.icael.org; www.icanl.org
          >
          >
          >
          > -----Original Message-----
          > From: Gerson Lichtenberg [mailto:gersonsl@s...]
          > Sent: Tuesday, July 27, 2004 11:16 PM
          > To: echocardiography@yahoogroups.com
          > Subject: Re: [echocardiography] ?standard procedure
          >
          >
          > This interesting discussion arises from time to time
          > in the field.
          >
          > Let me caution you about those who offer what sounds
          > like legal advice but are not lawyers. That should
          > make you nervous much as your own situation does. Your questions could

          > use a little clarification.
          >
          > 1) Are you talking about inserting the TEE probe
          > yourself, manipulating it, or simply operating the echocardiograph
          > while the anesthesiologist manages the probe? To put this in
          > perspective, TEEs were first done in the U.S. in the operating room,
          > with the anesthesiologists or gastro-enterologists teaching the
          > cardiologists to insert probes.
          >
          > 2) Are the Neonatologists taught to interpret
          > echocardiograms along with the echocardiographer? I
          > would expect them to have general expertise in
          > ultrasound and in fetal echocardiography. Or are you
          > just presenting them with a preliminary without
          > showing them the study?
          >
          > 3) Do you have any internal monitoring or education
          > process which attempts to get consistency in
          > preliminary reporting among the echocardiographers? Preliminary
          > reports are generally useless if the physician reports contradict them

          > later on.
          >
          > I won't give you advice on the preliminary reporting
          > issue, but my experience is that the ultrasound
          > community has never offered any support to the idea of
          > sonographers/echocardiographers providing reports to physicians other
          > than those doing the interpreting. The Scope of Practice that Nikki
          > mentions (available on the www.sdms.org site) is somewhat ambiguous. I
          > believe that the idea is that we can aid the physician
          > making the diagnosis.
          >
          > That being said, my own personal experience over a 25
          > year period is that preliminary reporting can be done
          > well under very controlled circumstances. I can't
          > promise that this is defensible legally, but your
          > situation is not unique.
          >
          > It is important to understand how the data from the echocardiogram is
          > used to make clinical decisions. If you understand the impact of what
          > you say, you can often provide the useful information without saying
          > all of the other findings that may be confusing or
          > irrelevant. Also, I sometimes say things in a way that
          > I know that a cardiologist would understand but that
          > the internist might find somewhat puzzling. This is
          > one of my ways of suggesting that they get a
          > cardiology consultation which will then increase the
          > speed with which the official echo interpretation will
          > get incorporated into the patient's medical care.
          >
          > Feel free to contact me directly if you have any
          > specific questions. Good luck!
          >
          > Gerson Lichtenberg, RDCS, APS
          > Cardiology
          > Rush Oak Park Hospital
          > Oak Park, Illinois
          >
          > --- Bob Hammler <echobob747@y...> wrote:
          > > I'm employed at a hospital that requires its
          > > echotechs to do some duties that I find questionable
          > > - is anyone else in this position?
          > > 1.Is it reasonable or legal to require echotechs
          > > to perform perioperative TEE's without
          > > a Cardiologist involved other than
          > > interpretation after the case is completed?
          > > 2.How about techs providing preliminary reports
          > > to Neonatologists with the Ped.
          > > Cardiologist interpretation available days or
          > > even weeks after treatment is given?
          > > 3.With Cardiologists becoming more and more
          > > scarce, we are increasingly being
          > > requested to provide preliminary reports to
          > > ordering physicians knowing that the
          > > the Cardiologist's interpretation will show up
          > > days after treatments are given?
          > >
          > > Am I being paranoid or am I being required to do
          > > things I shouldn't be doing?
          > > What resources are available to me?
          > >
          > >
          > >
          > >
          > >
          > >
          > >
          > >
          > >
          > >
          > >
          > >
          > >
          > >
          > >
          > >
          > >
          > >
          > >
          > >
          > >
          > >
          > >
          > >
          > >
          > > ---------------------------------
          > > Do you Yahoo!?
          > > New and Improved Yahoo! Mail - Send 10MB messages!
          >
          >
          >
          >
          > Yahoo! Groups Links




          Yahoo! Groups Links









          Yahoo! Groups Links
        • Gerson Lichtenberg
          Thanks for your input, Dr. Colman. Yours is the approach that many of us really hope to see. In addition, I hope to get feedback and from my cardiologists
          Message 4 of 20 , Jul 31, 2004
            Thanks for your input, Dr. Colman. Yours is the
            approach that many of us really hope to see. In
            addition, I hope to get feedback and from my
            cardiologists when they disagree or see something that
            I miss. This is how we get better.

            I also want to credit a friend and former employer of
            mine, Norm Lucas, for teaching me that I should always
            write my impression no matter what the working
            environment. This is the only way that the
            interpreting physician knows that I am thinking about
            what I am doing. Even if some of them normally ignore
            what we say, there is no chance that they will ever
            pay attention if we do not tell them our thoughts.
            Also, having to comment on our findings makes us pay
            more attention to our work and helps us to avoid
            presenting conflicting evidence.

            I give physicians a great deal of credit for what they
            go through to reach their positions of authority and
            responsibility. As for those physicians who 'rubber
            stamp' an echocardiographer's report, we should
            recognize that we cannot control what a physician does
            with our data. If we want to have the final say in
            medical diagnosis and/or decisions, it is up to us to
            spend the time, money and effort in school, residency
            and fellowship to reach that position.

            As the system works, it is up to each
            echocardiographer to demonstrate skill and judgement
            and to earn the respect of the rest of the
            echocardiography team. Thanks to Dr. Colman for your
            insight and to all who provide and participate in this
            list-serve for helping us support each other in this
            effort!

            Gerson Lichtenberg, RDCS, APS
            Cardiology
            Rush Oak Park Hospital
            Oak Park, Illinois

            --- Jack Colman <j.colman@...> wrote:
            > I see it differently.
            >
            > I see the preliminary report, provided by the
            > sonographer to the
            > interpreting cardiologist, as the assessment of one
            > trained professional
            > as to the content of the study. The second trained
            > professional, the
            > cardiologist, reviews the study, and adds his own
            > input into the
            > findings, and his interpretation, using the findings
            > of both reviewers.
            > Extra eyes on the study are only helpful. Sometimes
            > I see things the
            > sonographer missed. Sometimes I review a study and
            > realize I did not
            > appreciate what the sonographer put in the
            > preliminary report. Then I
            > go back and look again. Often I find that I can
            > agree, so I change the
            > final report to take both sets of eyes into
            > account. Sometimes I don't
            > agree; then, I report it the way I see it. It's my
            > report, and I'm "the
            > cardiologist" = that is my professional
            > responsibility. But I don't see
            > the sonographer as "doing my work for me; rather
            > s/;he is enhancing the
            > quality of the product not only by producing the
            > images, but by
            > reporting his/her assessment of them. We are
            > colleagues, not
            > competitors. The final responsibility, legally and
            > ethically, is the
            > responsibility of the physician. That's our system;
            > that's the nature
            > of our training and our mandate. But we work as a
            > team.
            >
            > Jack M. Colman MD, FRCPC
            > <mailto: j.colman@...>
            > Division of Cardiology, University of Toronto, at
            > Mount Sinai Hospital,
            > and
            > Toronto Congenital Cardiac Centre for Adults at
            > Toronto General
            > Hospital/UHN
            > 600 University Avenue, Suite 1603
            > Toronto, ON M5G 1X5
            > 416-586-5288 Fax 416-586-5968
            >
            >
            >
            > -----Original Message-----
            > From: oldechodude [mailto:mwadams@...]
            > Sent: July 29, 2004 7:53 PM
            > To: echocardiography@yahoogroups.com
            > Subject: [echocardiography] Re: ?standard procedure
            >
            >
            > Thanks for this input, Sandy. I was suckered into
            > preliminary
            > reporting over 15 years ago, but I soon realized
            > that some of the
            > physicians were "rubber stamping" my technical notes
            > and
            > observations. I ceased putting anything other than
            > measurements into
            > writing. I am very pleased that we have
            > guidelinelines, now, and
            > hope that everyone will adopt these. It's not just
            > a matter of
            > law...it's a matter of patient care....
            >
            > Mike
            >
            > --- In echocardiography@yahoogroups.com, "Sandy
            > Katanick"
            > <katanick@i...> wrote:
            > > I feel compelled to provide an ICAEL comment
            > regarding preliminary
            > reports.
            > > The ICAEL actually has written standards that
            > address the use of
            > preliminary
            > > reports in a clinical setting. The standards,
            > taken from
            > Organization
            > > Section 3, read as follows:
            > >
            > > 3.2.2 Preliminary reports prepared by the
            > physician should
            > be completed
            > > within 24 hours (verbal or written) with final
            > reports completed
            > within 48
            > > hours. STAT reports should be available
            > immediately, if
            > possible. URGENT
            > > reports should be available the same day.
            > >
            > > Note: Suggested method for reporting
            > life-threatening findings:
            > Optimally,
            > > the interpreting physician in the laboratory will
            > call the
            > appropriate
            > > physician. Alternatively, the sonographer will
            > call the
            > appropriate
            > > physician after conferring with the interpreting
            > physician.
            > >
            > > 3.2.3 If preliminary reports are issued, their
            > preliminary nature
            > should be
            > > clearly indicated. Verified final reports should
            > be provided
            > within 48 hours
            > > after the posting of preliminary results. A
            > mechanism for
            > communicating any
            > > significant changes must be defined for those
            > situations in which
            > the final
            > > interpretation differs substantially from the
            > preliminary report.
            > >
            > > Note: Sonographer worksheets, comments, or other
            > communication of findings
            > > must not be issued as preliminary reports for the
            > purpose of
            > clinical
            > > management.
            > >
            > > The ICAEL recognizes that sonographer preliminary
            > reports or
            > worksheets are
            > > often relied upon by the interpreting physician
            > when writing
            > his/her final
            > > report however the standards are very clear that
            > they should not
            > be issued
            > > to referring physicians for the purpose of
            > clinical management.
            > To view all
            > > of the ICAEL Standards please go to
            > >
            >
            http://www.intersocietal.org/icael/apply/standards.htm.
            > Thanks
            > Sandy
            > >
            > >
            > > Sandra L. Katanick, CAE
            > > Executive Director
            > > Intersocietal Accreditation Commission
            > > 8840 Stanford Boulevard, Suite 4900
            > > Columbia, Maryland 21045
            > > Phone: 410-872-0100 Fax: 410-872-0030
            > > Web Sites: www.icavl.org; www.icael.org;
            > www.icanl.org
            > >
            > >
            > >
            > > -----Original Message-----
            > > From: Gerson Lichtenberg [mailto:gersonsl@s...]
            > > Sent: Tuesday, July 27, 2004 11:16 PM
            > > To: echocardiography@yahoogroups.com
            > > Subject: Re: [echocardiography] ?standard
            > procedure
            > >
            > >
            > > This interesting discussion arises from time to
            > time
            > > in the field.
            > >
            > > Let me caution you about those who offer what
            > sounds
            > > like legal advice but are not lawyers. That should
            > > make you nervous much as your own situation does.
            > Your questions could
            >
            > > use a little clarification.
            > >
            > > 1) Are you talking about inserting the TEE probe
            > > yourself, manipulating it, or simply operating the
            > echocardiograph
            > > while the anesthesiologist manages the probe? To
            > put this in
            > > perspective, TEEs were first done in the U.S. in
            > the operating room,
            > > with the anesthesiologists or gastro-enterologists
            > teaching the
            > > cardiologists to insert probes.
            > >
            > > 2) Are the Neonatologists taught to interpret
            > > echocardiograms along with the echocardiographer?
            > I
            > > would expect them to have general expertise in
            > > ultrasound and in fetal echocardiography. Or are
            > you
            > > just presenting them with a preliminary without
            > > showing them the study?
            > >
            > > 3) Do you have any internal monitoring or
            > education
            > > process which attempts to get consistency in
            > > preliminary reporting among the
            > echocardiographers? Preliminary
            > > reports are generally useless if the physician
            > reports contradict them
            >
            > > later on.
            > >
            > > I won't give you advice on the preliminary
            > reporting
            > > issue, but my experience is that the ultrasound
            > > community has never offered any support to the
            > idea of
            > > sonographers/echocardiographers providing reports
            > to physicians other
            > > than those doing the interpreting. The Scope of
            > Practice that Nikki
            > > mentions (available on the www.sdms.org site) is
            > somewhat ambiguous. I
            > > believe that the idea is that we can aid the
            > physician
            > > making the diagnosis.
            > >
            > > That being said, my own personal experience over a
            > 25
            > > year period is that preliminary reporting can be
            > done
            > > well under very controlled circumstances. I can't
            > > promise that this is defensible legally, but your
            > > situation is not unique.
            > >
            > > It is important to understand how the data from
            > the echocardiogram is
            > > used to make clinical decisions. If you understand
            > the impact of what
            > > you say, you can often provide the useful
            > information without saying
            > > all of the other findings that may be confusing or
            > > irrelevant. Also, I sometimes say things in a way
            > that
            > > I know that a cardiologist would understand but
            > that
            > > the internist might find somewhat puzzling. This
            > is
            > > one of my ways of suggesting that they get a
            > > cardiology consultation which will then increase
            > the
            > > speed with which the official echo interpretation
            > will
            > > get incorporated into the patient's medical care.
            > >
            > > Feel free to contact me directly if you have any
            > > specific questions. Good luck!
            > >
            > > Gerson Lichtenberg, RDCS, APS
            > > Cardiology
            > > Rush Oak Park Hospital
            > > Oak Park, Illinois
            > >
            > > --- Bob Hammler <echobob747@y...> wrote:
            > > > I'm employed at a hospital that requires its
            > > > echotechs to do some duties that I find
            > questionable
            > > > - is anyone else in this position?
            > > > 1.Is it reasonable or legal to require
            > echotechs
            > > > to perform perioperative TEE's without
            > > > a Cardiologist involved other than
            > > > interpretation after the case is completed?
            > > > 2.How about techs providing preliminary
            > reports
            > > > to Neonatologists with the Ped.
            > > > Cardiologist interpretation available days
            > or
            > > > even weeks after treatment is given?
            > > > 3.With Cardiologists becoming more and more
            > > > scarce, we are increasingly being
            > > > requested to provide preliminary reports
            > to
            > > > ordering physicians knowing that the
            > > > the Cardiologist's interpretation will
            > show up
            > > > days after treatments are given?
            > > >
            > > > Am I being paranoid or am I being required to
            > do
            > > > things I shouldn't be doing?
            > > > What resources are available to me?
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > >
            > > > ---------------------------------
            > > > Do you Yahoo!?
            > > > New and Improved Yahoo! Mail - Send 10MB
            > messages!
            > >
            > >
            > >
            > >
            > > Yahoo! Groups Links
            >
            >
            >
            >
            > Yahoo! Groups Links
            >
            >
            >
            >
            >
            >
            >
            >
            >
            > Yahoo! Groups Links
            >
            >
            > echocardiography-unsubscribe@yahoogroups.com
            >
            >
            >
            >
          • Daskalakis Kosmas MD
            I wish to inform you that in Greece the only one able to practice a Echo is the cardiologist and nobody else. The figure of the sinographer does not exist, at
            Message 5 of 20 , Aug 2, 2004
              I wish to inform you that in Greece the only one able to practice a Echo is
              the cardiologist and nobody else. The figure of the sinographer does not
              exist, at least in cardiology
              ----- Original Message -----
              From: "Elizabeth Maher" <lizzymaher@...>
              To: <echocardiography@yahoogroups.com>
              Sent: Saturday, July 31, 2004 1:28 PM
              Subject: RE: [echocardiography] Re: ?standard procedure


              > I agree completely with Jack and this is how I work in Australia with
              > the various Cardiology practices. The sonographers produce the
              > preliminary report and the cardiologist reviews the study and the report
              > and either changes the preliminary or agrees completely.We work
              > together.
              >
              > Regards
              >
              > LM
              >
              >
              >
              > ---
              > Outgoing mail is certified Virus Free.
              > Checked by AVG anti-virus system (http://www.grisoft.com).
              > Version: 6.0.718 / Virus Database: 474 - Release Date: 9/07/2004
              >
              >
              >
              >
              >
              > Yahoo! Groups Links
              >
              >
              >
              >
              >
              >
              >
            • SHELLY WALKER
              I agree with this also, however, not everyone is as respectable about this. At our hospital, we filled out a preliminary report for the cardiologist which they
              Message 6 of 20 , Aug 2, 2004
                I agree with this also, however, not everyone is as respectable about this.
                At our hospital, we filled out a preliminary report for the cardiologist
                which they found to be extremely helpful. I would make sure to note any
                unusual findings (i.e. questionable clot, etc) that I wanted to make sure
                the cardiologist took note of. Especially if it is easily missed (i.e. only
                seen in one view). It made me feel respected when the physicians trusted my
                opinion. The way I approached it is if I was 100% sure I gave my opinion,
                if I was in question, I told them I was sure. One general practitioner
                would always ask me what the EF was to determine discharge. I didn't mind
                telling her the EF, but I didn't want discharge being determined by my
                observation. Another situation, I had a 52 year old with an aortic
                dissection that went from his aortic valve, up his right carotid, and down
                his descending aorta. I had to call the cardiologist to alert him so he
                didn't go through with the stress test he was planning. By the time I had
                gotten the patient to the ER, he was being transferred out for emergency
                repair in a few hours. The cardiologist never even looked at the tape. I
                had to call the ER doctor and ask him to please confirm it with a CT, which
                he did. I trust myself on what I see, however, I respect the fact that I
                did not go to medical school and may be wrong. Also we have 26 cardiologist
                in our 64 bed hospital and I only trust a handful of them. I just make sure
                to be VERY careful of what I say and to whom. I think it is a grey area and
                you have to use your better judgement. We were always taught the headline
                test. If is something that would make the headline in the newspaper - DON'T
                DO IT!

                Shelly Walker, RDCS, RVS
                13014 Poydras Court
                Cypress, TX 77429
                shelly.walker@...
                Home: (281) 225-6186
                Cell: (281) 536-1080
                -----Original Message-----
                From: Hogan, Candy [mailto:candy.hogan@...]
                Sent: Friday, July 30, 2004 8:25 PM
                To: echocardiography@yahoogroups.com
                Subject: RE: [echocardiography] Re: ?standard procedure

                What a great response. I also agree with this. We do a complete draft
                report off of our digital reporting system and the physician reviews the
                images and report at the same time. This makes all of my Sonographers
                competent in what they do. They have learned so much by doing this. Our
                Cardiologist have so much respect for the Sonographers and they have more
                time to spend with their patients!

                Candy Hogan, RDCS
                Cardiology/Echocardiography/EEG Supervisor
                6001 Norris Canyon Rd.
                San Ramon, CA 94538
                candy.hogan@... <mailto:candy.hogan@...>
                925-275-8846 Direct line
                925-275-8287 Office
                925-275-8397 Fax



                -----Original Message-----
                From: Jack Colman [mailto:j.colman@...]
                Sent: Friday, July 30, 2004 6:51 AM
                To: echocardiography@yahoogroups.com
                Subject: RE: [echocardiography] Re: ?standard procedure


                I see it differently.

                I see the preliminary report, provided by the sonographer to the
                interpreting cardiologist, as the assessment of one trained professional
                as to the content of the study. The second trained professional, the
                cardiologist, reviews the study, and adds his own input into the
                findings, and his interpretation, using the findings of both reviewers.
                Extra eyes on the study are only helpful. Sometimes I see things the
                sonographer missed. Sometimes I review a study and realize I did not
                appreciate what the sonographer put in the preliminary report. Then I
                go back and look again. Often I find that I can agree, so I change the
                final report to take both sets of eyes into account. Sometimes I don't
                agree; then, I report it the way I see it. It's my report, and I'm "the
                cardiologist" = that is my professional responsibility. But I don't see
                the sonographer as "doing my work for me; rather s/;he is enhancing the
                quality of the product not only by producing the images, but by
                reporting his/her assessment of them. We are colleagues, not
                competitors. The final responsibility, legally and ethically, is the
                responsibility of the physician. That's our system; that's the nature
                of our training and our mandate. But we work as a team.

                Jack M. Colman MD, FRCPC
                <mailto: j.colman@...>
                Division of Cardiology, University of Toronto, at Mount Sinai Hospital,
                and
                Toronto Congenital Cardiac Centre for Adults at Toronto General
                Hospital/UHN
                600 University Avenue, Suite 1603
                Toronto, ON M5G 1X5
                416-586-5288 Fax 416-586-5968



                -----Original Message-----
                From: oldechodude [mailto:mwadams@...]
                Sent: July 29, 2004 7:53 PM
                To: echocardiography@yahoogroups.com
                Subject: [echocardiography] Re: ?standard procedure


                Thanks for this input, Sandy. I was suckered into preliminary
                reporting over 15 years ago, but I soon realized that some of the
                physicians were "rubber stamping" my technical notes and
                observations. I ceased putting anything other than measurements into
                writing. I am very pleased that we have guidelinelines, now, and
                hope that everyone will adopt these. It's not just a matter of
                law...it's a matter of patient care....

                Mike

                --- In echocardiography@yahoogroups.com, "Sandy Katanick"
                <katanick@i...> wrote:
                > I feel compelled to provide an ICAEL comment regarding preliminary
                reports.
                > The ICAEL actually has written standards that address the use of
                preliminary
                > reports in a clinical setting. The standards, taken from
                Organization
                > Section 3, read as follows:
                >
                > 3.2.2 Preliminary reports prepared by the physician should
                be completed
                > within 24 hours (verbal or written) with final reports completed
                within 48
                > hours. STAT reports should be available immediately, if
                possible. URGENT
                > reports should be available the same day.
                >
                > Note: Suggested method for reporting life-threatening findings:
                Optimally,
                > the interpreting physician in the laboratory will call the
                appropriate
                > physician. Alternatively, the sonographer will call the
                appropriate
                > physician after conferring with the interpreting physician.
                >
                > 3.2.3 If preliminary reports are issued, their preliminary nature
                should be
                > clearly indicated. Verified final reports should be provided
                within 48 hours
                > after the posting of preliminary results. A mechanism for
                communicating any
                > significant changes must be defined for those situations in which
                the final
                > interpretation differs substantially from the preliminary report.
                >
                > Note: Sonographer worksheets, comments, or other
                communication of findings
                > must not be issued as preliminary reports for the purpose of
                clinical
                > management.
                >
                > The ICAEL recognizes that sonographer preliminary reports or
                worksheets are
                > often relied upon by the interpreting physician when writing
                his/her final
                > report however the standards are very clear that they should not
                be issued
                > to referring physicians for the purpose of clinical management.
                To view all
                > of the ICAEL Standards please go to
                > http://www.intersocietal.org/icael/apply/standards.htm. Thanks
                Sandy
                >
                >
                > Sandra L. Katanick, CAE
                > Executive Director
                > Intersocietal Accreditation Commission
                > 8840 Stanford Boulevard, Suite 4900
                > Columbia, Maryland 21045
                > Phone: 410-872-0100 Fax: 410-872-0030
                > Web Sites: www.icavl.org; www.icael.org; www.icanl.org
                >
                >
                >
                > -----Original Message-----
                > From: Gerson Lichtenberg [mailto:gersonsl@s...]
                > Sent: Tuesday, July 27, 2004 11:16 PM
                > To: echocardiography@yahoogroups.com
                > Subject: Re: [echocardiography] ?standard procedure
                >
                >
                > This interesting discussion arises from time to time
                > in the field.
                >
                > Let me caution you about those who offer what sounds
                > like legal advice but are not lawyers. That should
                > make you nervous much as your own situation does. Your questions could

                > use a little clarification.
                >
                > 1) Are you talking about inserting the TEE probe
                > yourself, manipulating it, or simply operating the echocardiograph
                > while the anesthesiologist manages the probe? To put this in
                > perspective, TEEs were first done in the U.S. in the operating room,
                > with the anesthesiologists or gastro-enterologists teaching the
                > cardiologists to insert probes.
                >
                > 2) Are the Neonatologists taught to interpret
                > echocardiograms along with the echocardiographer? I
                > would expect them to have general expertise in
                > ultrasound and in fetal echocardiography. Or are you
                > just presenting them with a preliminary without
                > showing them the study?
                >
                > 3) Do you have any internal monitoring or education
                > process which attempts to get consistency in
                > preliminary reporting among the echocardiographers? Preliminary
                > reports are generally useless if the physician reports contradict them

                > later on.
                >
                > I won't give you advice on the preliminary reporting
                > issue, but my experience is that the ultrasound
                > community has never offered any support to the idea of
                > sonographers/echocardiographers providing reports to physicians other
                > than those doing the interpreting. The Scope of Practice that Nikki
                > mentions (available on the www.sdms.org site) is somewhat ambiguous. I
                > believe that the idea is that we can aid the physician
                > making the diagnosis.
                >
                > That being said, my own personal experience over a 25
                > year period is that preliminary reporting can be done
                > well under very controlled circumstances. I can't
                > promise that this is defensible legally, but your
                > situation is not unique.
                >
                > It is important to understand how the data from the echocardiogram is
                > used to make clinical decisions. If you understand the impact of what
                > you say, you can often provide the useful information without saying
                > all of the other findings that may be confusing or
                > irrelevant. Also, I sometimes say things in a way that
                > I know that a cardiologist would understand but that
                > the internist might find somewhat puzzling. This is
                > one of my ways of suggesting that they get a
                > cardiology consultation which will then increase the
                > speed with which the official echo interpretation will
                > get incorporated into the patient's medical care.
                >
                > Feel free to contact me directly if you have any
                > specific questions. Good luck!
                >
                > Gerson Lichtenberg, RDCS, APS
                > Cardiology
                > Rush Oak Park Hospital
                > Oak Park, Illinois
                >
                > --- Bob Hammler <echobob747@y...> wrote:
                > > I'm employed at a hospital that requires its
                > > echotechs to do some duties that I find questionable
                > > - is anyone else in this position?
                > > 1.Is it reasonable or legal to require echotechs
                > > to perform perioperative TEE's without
                > > a Cardiologist involved other than
                > > interpretation after the case is completed?
                > > 2.How about techs providing preliminary reports
                > > to Neonatologists with the Ped.
                > > Cardiologist interpretation available days or
                > > even weeks after treatment is given?
                > > 3.With Cardiologists becoming more and more
                > > scarce, we are increasingly being
                > > requested to provide preliminary reports to
                > > ordering physicians knowing that the
                > > the Cardiologist's interpretation will show up
                > > days after treatments are given?
                > >
                > > Am I being paranoid or am I being required to do
                > > things I shouldn't be doing?
                > > What resources are available to me?
                > >
                > >
                > >
                > >
                > >
                > >
                > >
                > >
                > >
                > >
                > >
                > >
                > >
                > >
                > >
                > >
                > >
                > >
                > >
                > >
                > >
                > >
                > >
                > >
                > >
                > > ---------------------------------
                > > Do you Yahoo!?
                > > New and Improved Yahoo! Mail - Send 10MB messages!
                >
                >
                >
                >
                > Yahoo! Groups Links




                Yahoo! Groups Links









                Yahoo! Groups Links









                Yahoo! Groups Links
              • Mhibby@AOL.com
                Once again this list comes through with some great personal experiences and thoughts about challenges we all face throughout a typical day. Thanks for sharing
                Message 7 of 20 , Aug 3, 2004
                  Once again this list comes through with some great personal experiences and thoughts about challenges we all face throughout a typical day. Thanks for sharing and I also want to thank those who have written responses for putting their full name and where they work in the closing. For me that really helps me appreciate how things are done in not only in different parts of the country but different parts of the world--which seems to be getting smaller every day.

                  Thanks for sharing such interesting experiences!  I am very fortunate to work with a group of cardiologists that help and support me through some very busy days.  We talk a lot about what is seen in each study and I always feel that my input is valued.  There are times when I am not right--but unless you speak your mind you will never know or learn from your mistakes.  I do believe that I am one of the fortunate ones because I hear thank you's at the end of day and often throughout the day.  Funny how those little words can make such a huge difference. 

                  Barbara Hibdon
                  Rocky Mountain Pediatrix Cardiology
                  10103 RidgeGate Parkway
                  Lone Tree, CO   80124
                  303-860-9933
                        
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