“To Do or Not To Do?” Clinical Integration of Point-Of-Care Ultrasound After Training: A Prospective Study

2020 ◽  
Author(s):  
Wan-Ching Lien ◽  
Chih-Heng Chang ◽  
Kah-Meng Chong ◽  
Meng-Che Wu ◽  
Cheng-Yi Wu ◽  
...  
Keyword(s):  
Image Quality ◽  
Prospective Study ◽  
Patient Care ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Global Rating ◽  
Clinical Integration ◽  
Valuable Adjunct ◽  
Global Ratings ◽  
Group 1

Abstract Background: Point-of-care ultrasound (PoCUS) can serve as a valuable adjunct for patient care. This study aimed to investigate the clinical integration of PoCUS of the first post-graduate year (PGY-1) residents after a PoCUS curriculum.Methods: The prospective study was conducted at the emergency department (ED) of the National Taiwan University Hospital between July 2015 and October 2017. Every PGY-1 resident had one-month ED training and a PoCUS curriculum was implemented during the first week. The post-training objective structured clinical examination global ratings were obtained, as well as the sonographic examinations the residents performed on shifts. Four groups could be identified: group 1 performed PoCUS before and after the curriculum; group 2 performed only after the curriculum; group 3 performed only before the curriculum; the last did not perform any examinations.Results: 239 residents participated. The median global rating was 4 (interquartile ranges, 4-5). After the curriculum, an increasing number of residents integrated PoCUS into patient care (64 vs. 170, p=0.037) with acceptable image quality. No differences existed in the global ratings between 4 groups, however, nearly 30% of residents did not use PoCUS during their shifts. Group 1 performed more cases with better image quality and using ≥2 US applications (8/100 vs. 82/359, p=0.0009), compared with those before the curriculum. Comparing with those in groups 1 and 2, group 1 performed more cases (p<0.0001) with better image quality (p=0.03). “No suitable cases” (25/69), and “choosing other imaging priorities” (43/69) were the main feedbacks in groups 3 and 4.Conclusions: A short focused US training had an immediate positive impact on OSCE global ratings and integration of PoCUS of PGY-1 residents in the ED. The global ratings could not predict whether to use PoCUS in the ED practice. Although the working climate was designated to be friendly for utilizing US, a substantial percentage of residents did not use PoCUS. Further longitudinal studies would be needed for the sustained effects of the curriculum.Trial registration: NCT03738033.

scholarly journals Clinical Utilization of Point-of-care Ultrasound After Training: A Prospective Study

2021 ◽  
Author(s):  
Wan-Ching Lien ◽  
Chih-Heng Chang ◽  
Kah-Meng Chong ◽  
Meng-Che Wu ◽  
Cheng-Yi Wu ◽  
...  
Keyword(s):  
Image Quality ◽  
Positive Impact ◽  
University Hospital ◽  
Point Of Care Ultrasound ◽  
Global Rating ◽  
Clinical Trial Registration ◽  
Clinical Utilization ◽  
Global Ratings ◽  
Group 2 ◽  
Group 1

Abstract Background: This study aimed to investigate the clinical utilization of PoCUS of the first post-graduate year residents after a PoCUS curriculum. Methods: It was conducted at the emergency department of the National Taiwan University Hospital between July 2015 and October 2017. Every resident had one-month ED training and a curriculum was implemented during the first week. The post-training objective structured clinical examination (OSCE) global ratings were obtained, as well as the sonographic examinations by the residents. The participants were categorized into 4 groups: group 1 performed PoCUS before and after the curriculum; group 2 performed only after the curriculum; group 3 performed only before the curriculum; the last did not perform any examinations. Results: Two hundred and thirty-nine residents participated. The median global rating was 4 (interquartile ranges, 4-5). A significantly increasing number of residents integrated PoCUS into patient care (64 vs. 170, p=0.037) with acceptable image quality after the curriculum. Nearly 30% of residents did not use PoCUS although no differences existed in the OSCE global ratings. Group 1 performed more cases with better image quality and using ≥2 ultrasound applications (8/100 vs. 82/359, p=0.0009) after the curriculum. Group 1 performed more cases with better image quality than group 2 after the curriculum. In groups 3 and 4, “no suitable cases” (25/69), and “choosing other imaging priorities” (43/69) were the main feedbacks for not performing PoCUS. Conclusions: A focused training had a substantial positive impact on the utilization of PoCUS of the residents. The global ratings could not predict whether to integrate PoCUS into clinical practice. Further studies would be needed for the sustained effects of the curriculum and how to encourage these residents in groups 3 and 4 to use PoCUS.Clinical trial registration: NCT03738033.

scholarly journals Bridging the logistical gap between ultrasound enthusiasm and accreditation

2017 ◽  
Vol 19 (1) ◽  
pp. 15-18 ◽  
Author(s):  
George Reid ◽  
Jonathan Bedford ◽  
Ben Attwood
Keyword(s):  
Intensive Care ◽  
Patient Care ◽  
Intensive Care Medicine ◽  
Point Of Care ◽  
Time Constraints ◽  
Point Of Care Ultrasound ◽  
Web Based ◽  
Geographical Factors ◽  
Valuable Adjunct ◽  
Clinical Mentorship

Point-of-care ultrasound is increasingly recognised as a valuable adjunct to patient care. Trainees in intensive care medicine are expected to accredit in focused intensive care echocardiography, but the availability of trained mentors and logistical/geographical factors make this difficult within the time constraints required. As a result, many trainees who are enthusiastic about point-of-care ultrasound find it difficult to achieve accreditation. We present a secure, web-based, multi-user system which mitigates many of these difficulties and allows for clinical mentorship to take place without geographical barriers, and at a time convenient for the participants.

scholarly journals LO85: Development of a competency based assessment tool for emergency department point of care ultrasound

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S38-S39
Author(s):  
C. McKaigney ◽  
C. Bell ◽  
A. Hall
Keyword(s):  
Delphi Method ◽  
Assessment Tool ◽  
Point Of Care ◽  
Image Acquisition ◽  
Clinical Indication ◽  
Point Of Care Ultrasound ◽  
Clinical Integration ◽  
Modified Delphi Method ◽  
Modified Delphi ◽  
Image Optimization

Innovation Concept: Assessment of residents' Point of Care Ultrasound (PoCUS) competency currently relies on heterogenous and unvalidated methods, such as the completion of a number of proctored studies. Although number of performed studies may be associated with ability, it is not necessarily a surrogate for competence. Our goal was to create a single Ultrasound Competency Assessment Tool (UCAT) using domain-anchored entrustment scoring. Methods: The UCAT was developed as an anchored global assessment score, building on a previously validated simulation-based assessment tool. It was designed to measure performance across the domains of Preparation, Image Acquisition, Image Optimization, and Clinical Integration, in addition to providing a final entrustment score (i.e., OSCORE). A modified Delphi method was used to establish national expert consensus on anchors for each domain. Three surveys were distributed to the CAEP Ultrasound Committee between July-November 2018. The first survey asked members to appraise and modify a list of anchor options created by the authors. Next, collated responses from the first survey were redistributed for a re-appraisal. Finally, anchors obtaining &gt;65% approval from the second survey were condensed and redistributed for final consensus. Curriculum, Tool or Material: Twenty-two, 26, and 22 members responded to the surveys, respectively. Each anchor achieved &gt;90% final agreement. The final anchors for the domains were: Preparation – positioning, initial settings, ensures clean transducer, probe selection, appropriate clinical indication; Image Acquisition – appropriate measurements, hand position, identifies landmarks, visualization of target, efficiency of probe motion, troubleshoots technical limitations; Image Optimization – centers area of interest, overall image quality, troubleshoots patient obstacles, optimizes settings; Clinical Integration – appropriate interpretation, understands limitations, utilizes information appropriately, performs multiple scans if needed, communicates findings, considers false positive and negative causes of findings. Conclusion: The UCAT is a novel assessment tool that has the potential to play a central role in the training and evaluation of residents. Our use of a modified Delphi method, involving key stakeholders in PoCUS education, ensures that the UCAT has a high degree of process and content validity. An important next step in determining its construct validity is to evaluate the use of the UCAT in a multi-centered examination setting.

scholarly journals POINT: Should the Use of Diagnostic Point-of-Care Ultrasound in Patient Care Require Hospital Privileging/Credentialing? Yes

CHEST Journal ◽  
2020 ◽  
Vol 157 (3) ◽  
pp. 496-498 ◽  
Author(s):  
James M. Walter ◽  
Lewis Satterwhite ◽  
Kenneth E. Lyn-Kew
Keyword(s):  
Patient Care ◽  
Point Of Care ◽  
Point Of Care Ultrasound

Accuracy of point of care ultrasound to identify the source of infection in septic patients: a prospective study

2016 ◽  
Vol 12 (3) ◽  
pp. 371-378 ◽  
Author(s):  
Francesca Cortellaro ◽  
Laura Ferrari ◽  
Francesco Molteni ◽  
Paolo Aseni ◽  
Marta Velati ◽  
...  
Keyword(s):  
Prospective Study ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Source Of Infection ◽  
A Prospective Study

scholarly journals Rural point-of-care ultrasound of the kidney and bladder: quality and effect on patient management

2018 ◽  
Vol 10 (4) ◽  
pp. 324 ◽  
Author(s):  
Garry Nixon ◽  
Katharina Blattner ◽  
Jill Muirhead ◽  
Ngaire Kerse
Keyword(s):  
Patient Care ◽  
Urinary Retention ◽  
Point Of Care ◽  
Renal Stones ◽  
Point Of Care Ultrasound ◽  
Ultrasound Images ◽  
Positive Contribution ◽  
Diagnostic Certainty ◽  
Negative Effect ◽  
Clinical Records

ABSTRACT INTRODUCTION Point-of-care ultrasound (POCUS) of the kidney and bladder are among the most commonly performed POCUS scans in rural New Zealand (NZ). AIM To determine the quality, safety and effect on patient care of POCUS of the kidney and bladder in rural NZ. METHODS Overall, 28 doctors in six NZ rural hospitals completed a questionnaire both before and after undertaking a POCUS scan over a 9-month period. The clinical records and saved ultrasound images were reviewed by a specialist panel. RESULTS The 28 participating doctors undertook 138 kidney and 60 bladder scans during the study. POCUS of the bladder as a test for urinary retention had a sensitivity of 100% (95% CI 88–100) and specificity of 100% (95% CI 93–100). POCUS of the kidney as a test for hydronephrosis had a sensitivity 90% (95% CI 74–96) and specificity of 96% (95% CI 89–98). The accuracy of other findings such as renal stones and bladder clot was lower. POCUS of the bladder appeared to have made a positive contribution to patient care in 92% of cases without evidence of harm. POCUS of the kidney benefited 93% of cases, although in three cases (2%), it may have had a negative effect on patient care. DISCUSSION POCUS as a test for urinary retention and hydronephrosis in the hands of rural doctors was technically straightforward, improved diagnostic certainty, increased discharges and overall had a positive effect on patient care.

scholarly journals Model Point-of-Care Ultrasound Curriculum in an Intensive Care Unit Fellowship Program and Its Impact on Patient Management

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Keith Killu ◽  
Victor Coba ◽  
Michael Mendez ◽  
Subhash Reddy ◽  
Tanja Adrzejewski ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Care ◽  
Patient Management ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Fellowship Program ◽  
Icu Patients ◽  
Surgical Icu ◽  
New Diagnosis

Objectives. This study was designed to assess the clinical applicability of a Point-of-Care (POC) ultrasound curriculum into an intensive care unit (ICU) fellowship program and its impact on patient care.Methods. A POC ultrasound curriculum for the surgical ICU (SICU) fellowship was designed and implemented in an urban, academic tertiary care center. It included 30 hours of didactics and hands-on training on models. Minimum requirement for each ICU fellow was to perform 25–50 exams on respective systems or organs for a total not less than 125 studies on ICU. The ICU fellows implemented the POC ultrasound curriculum into their daily practice in managing ICU patients, under supervision from ICU staff physicians, who were instructors in POC ultrasound. Impact on patient care including finding a new diagnosis or change in patient management was reviewed over a period of one academic year.Results. 873 POC ultrasound studies in 203 patients admitted to the surgical ICU were reviewed for analysis. All studies included were done through the POC ultrasound curriculum training. The most common exams performed were 379 lung/pleural exams, 239 focused echocardiography and hemodynamic exams, and 237 abdominal exams. New diagnosis was found in 65.52% of cases (95% CI 0.590, 0.720). Changes in patient management were found in 36.95% of cases (95% CI 0.303, 0.435).Conclusions. Implementation of POC ultrasound in the ICU with a structured fellowship curriculum was associated with an increase in new diagnosis in about 2/3 and change in management in over 1/3 of ICU patients studied.

Use of Critical Items in Determining Point-of-Care Ultrasound Competence

2020 ◽  
pp. 016327872097583
Author(s):  
Janeve Desy ◽  
Vicki E. Noble ◽  
Michael Y. Woo ◽  
Michael Walsh ◽  
Andrew W. Kirkpatrick ◽  
...  
Keyword(s):  
Interrater Reliability ◽  
Delphi Technique ◽  
Point Of Care ◽  
Critical Item ◽  
Intraclass Correlation ◽  
Point Of Care Ultrasound ◽  
Cut Scores ◽  
Modified Delphi ◽  
Global Ratings ◽  
Modified Delphi Technique

We previously developed a workplace-based tool for assessing point of care ultrasound (POCUS) skills and used a modified Delphi technique to identify critical items (those that learners must successfully complete to be considered competent). We performed a standard setting procedure to determine cut scores for the full tool and a focused critical item tool. This study compared ratings by 24 experts on the two checklists versus a global entrustability rating. All experts assessed three videos showing an actor performing a POCUS exam on a patient. The performances were designed to show a range of competences and one included potentially critical errors. Interrater reliability for the critical item tool was higher than for the full tool (intraclass correlation coefficient = 0.84 [95% confidence interval [CI] 0.42–0.99] vs. 0.78 [95% CI 0.25–0.99]). Agreement with global ratings of competence was higher for the critical item tool (κ = 0.71 [95% CI 0.55–0.88] vs 0.48 [95% CI 0.30–0.67]). Although sensitivity was higher for the full tool (85.4% [95% CI 72.2–93.9%] vs. 81.3% [95% CI 67.5–91.1%]), specificity was higher for the critical item tool (70.8% [95% CI 48.9–87.4%] vs. 29.2% [95% CI 12.6–51.1%]). We recommend the use of critical item checklists for the assessment of POCUS competence.

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