Decreasing Ghost Scanning in Point-of-Care Ultrasound: Impact of a Visual Prompt to Save Images

Ghost scanning, performance of point-of-care ultrasound without image archival, can adversely affect patient care, billing, quality assurance, and result in medicolegal concerns. This study evaluated the Extended Focused Assessment with Sonography in Trauma (eFAST) ghost-scanning rate during trauma activations after placement of a low-cost visual reminder.

This single-center study was conducted from December 1, 2022 to November 30, 2023. Patients were included if they were the highest level of emergency department trauma activation. A ghost scan was classified as a documented eFAST examination in the electronic medical record nursing documentation without archived eFAST images in the picture-archiving and communication system. Six months of EMR review established a baseline ghost-scanning rate. Subsequently, a large label reminding clinicians to save images was placed prominently on the ultrasound machines for a six-month period with prospective chart review. The primary outcome was the absolute and relative difference in ghost-scanning rates after the label intervention. Differences between periods were analyzed using a two-tailed Mann-Whitney U test.

A total of 325 trauma encounters were included. In the pre-intervention period, 66 eFAST examinations were identified among 143 encounters, of which 74.2% (49) were ghost scans. In the post-intervention period, 86 eFAST examinations were identified among 182 encounters, of which 54.7% (47) were ghost scans, representing a 19.5% absolute reduction (p = 0.013).

The low-cost visual reminder was associated with a meaningful reduction in ghost scanning during eFAST examinations. Further investigation into similar interventions and their generalizability to other institutions is warranted.