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Kim DJ, Atkinson P, Sheppard G, Chenkin J, Thavanathan R, Lewis D, Bell CR, Jelic T, Lalande E, Buchanan IM, Heslop CL, Burwash-Brennan T, Myslik F, Olszynski P. POCUS literature primer: key papers on POCUS in cardiac arrest and shock. CAN J EMERG MED 2024; 26:15-22. [PMID: 37996693 DOI: 10.1007/s43678-023-00611-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/25/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE The objective of this study is to identify the top five most influential papers published on the use of point-of-care ultrasound (POCUS) in cardiac arrest and the top five most influential papers on the use of POCUS in shock in adult patients. METHODS An expert panel of 14 members was recruited from the Canadian Association of Emergency Physicians (CAEP) Emergency Ultrasound Committee and the Canadian Ultrasound Fellowship Collaborative. The members of the panel are ultrasound fellowship trained or equivalent, are engaged in POCUS research, and are leaders in POCUS locally and nationally in Canada. A modified Delphi process was used, consisting of three rounds of sequential surveys and discussion to achieve consensus on the top five most influential papers for the use of POCUS in cardiac arrest and shock. RESULTS The panel identified 39 relevant papers on POCUS in cardiac arrest and 42 relevant papers on POCUS in shock. All panel members participated in all three rounds of the modified Delphi process, and we ultimately identified the top five most influential papers on POCUS in cardiac arrest and also on POCUS in shock. Studies include descriptions and analysis of safe POCUS protocols that add value from a diagnostic and prognostic perspective in both populations during resuscitation. CONCLUSION We have developed a reading list of the top five influential papers on the use of POCUS in cardiac arrest and shock to better inform residents, fellows, clinicians, and researchers on integrating and studying POCUS in a more evidence-based manner.
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Affiliation(s)
- Daniel J Kim
- Department of Emergency Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
| | - Paul Atkinson
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Gillian Sheppard
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John's, NF, Canada
| | - Jordan Chenkin
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rajiv Thavanathan
- Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - David Lewis
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Colin R Bell
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Tomislav Jelic
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Elizabeth Lalande
- Department of Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Ian M Buchanan
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Claire L Heslop
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Talia Burwash-Brennan
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
| | - Frank Myslik
- Division of Emergency Medicine, Department of Medicine, Western University, London, ON, Canada
| | - Paul Olszynski
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Kim DJ, Bell CR, Jelic T, Thavanathan R, Heslop CL, Myslik F, Lewis D, Atkinson P, Chenkin J, Buchanan IM, Olszynski P, Sheppard G, Burwash-Brennan T, Lalande E. Point-of-Care Ultrasound (POCUS) Literature Primer: Key Papers on Renal and Biliary POCUS. Cureus 2023; 15:e37294. [PMID: 37168176 PMCID: PMC10166360 DOI: 10.7759/cureus.37294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/08/2023] [Indexed: 05/13/2023] Open
Abstract
Objective The objective of this study is to identify the top five influential papers published on renal point-of-care ultrasound (POCUS) and the top five influential papers on biliary POCUS in adult patients. Methods A 14-member expert panel was recruited from the Canadian Association of Emergency Physicians (CAEP) Emergency Ultrasound Committee and the Canadian Ultrasound Fellowship Collaborative. All panel members have had ultrasound fellowship training or equivalent, are actively engaged in POCUS scholarship, and are involved with POCUS at their local site and nationally in Canada. We used a modified Delphi process consisting of three rounds of sequential surveys and discussion to achieve consensus on the top five influential papers for renal POCUS and biliary POCUS. Results The panel identified 27 relevant papers on renal POCUS and 30 relevant papers on biliary POCUS. All panel members participated in all three rounds of the modified Delphi process, and after completing this process, we identified the five most influential papers on renal POCUS and the five most influential papers on biliary POCUS. Conclusion We have developed a list, based on expert opinion, of the top five influential papers on renal and biliary POCUS to better inform all trainees and clinicians on how to use these applications in a more evidence-based manner. This list will also be of interest to clinicians and researchers who strive to further advance the field of POCUS.
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Affiliation(s)
- Daniel J Kim
- Department of Emergency Medicine, University of British Columbia, Vancouver, CAN
- Department of Emergency Medicine, Vancouver General Hospital, Vancouver, CAN
| | - Colin R Bell
- Department of Emergency Medicine, University of Calgary, Calgary, CAN
| | - Tomislav Jelic
- Department of Emergency Medicine, University of Manitoba, Winnipeg, CAN
| | | | - Claire L Heslop
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, CAN
| | - Frank Myslik
- Department of Emergency Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, CAN
| | - David Lewis
- Department of Emergency Medicine, Saint John Regional Hospital, Saint John, CAN
- Department of Emergency Medicine, Dalhousie University New Brunswick, Saint John, CAN
| | - Paul Atkinson
- Department of Emergency Medicine, Saint John Regional Hospital, Saint John, CAN
- Department of Emergency Medicine, Dalhousie University New Brunswick, Saint John, CAN
| | - Jordan Chenkin
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, CAN
| | - Ian M Buchanan
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, CAN
| | - Paul Olszynski
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, CAN
| | - Gillian Sheppard
- Department of Emergency Medicine, Memorial University of Newfoundland, St. John's, CAN
| | | | - Elizabeth Lalande
- Department of Emergency Medicine, Université Laval, Quebec City, CAN
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Johri AM, Glass C, Hill B, Jensen T, Puentes W, Olusanya O, Capizzano JN, Dancel R, Reierson K, Reisinger N, Liblik K, Galen BT. The Evolution of Cardiovascular Ultrasound: A Review of Cardiac Point-of-Care Ultrasound (POCUS) Across Specialties. Am J Med 2023:S0002-9343(23)00158-4. [PMID: 36889497 DOI: 10.1016/j.amjmed.2023.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023]
Abstract
The use of cardiac point-of-care ultrasound (POCUS) is now widespread in clinics, emergency departments, and all areas of the hospital. Users include medical trainees, advanced practice practitioners, and attending physicians in many specialties and sub-specialties. Opportunities to learn cardiac POCUS and requirements for training vary across specialties as does the scope of the cardiac POCUS examination. In this review, we describe both a brief history of how cardiac POCUS emerged from echocardiography and the state of the art across a variety of medical fields.
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Affiliation(s)
- Amer M Johri
- Department of Medicine, Queen's University, Kingston, ON, Canada.
| | - Casey Glass
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Braeden Hill
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Trevor Jensen
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Wilfredo Puentes
- Department of Anesthesia, Western University, London, ON, Canada
| | - Olusegun Olusanya
- Department of Critical Care, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | | | - Ria Dancel
- Departments of Internal Medicine and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Kreegan Reierson
- Department of Hospital Medicine, HealthPartners Medical Group, Minnesota and Wisconsin, USA
| | - Nathaniel Reisinger
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Kiera Liblik
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Benjamin T Galen
- Department of Internal Medicine, Division of Hospital Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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Kim DJ, Bell C, Jelic T, Sheppard G, Robichaud L, Burwash-Brennan T, Chenkin J, Lalande E, Buchanan I, Atkinson P, Thavanathan R, Heslop C, Myslik F, Lewis D. Point of Care Ultrasound Literature Primer: Key Papers on Focused Assessment With Sonography in Trauma (FAST) and Extended FAST. Cureus 2022; 14:e30001. [PMID: 36348832 PMCID: PMC9637006 DOI: 10.7759/cureus.30001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
Abstract
Objective The objective of this study is to identify the top five most influential papers published on focused assessment with sonography in trauma (FAST) and the top five most influential papers on the extended FAST (E-FAST) in adult patients. Methods An expert panel was recruited from the Canadian Association of Emergency Physicians (CAEP) Emergency Ultrasound Committee and the Canadian Ultrasound Fellowship Collaborative. These experts are ultrasound fellowship-trained or equivalent, are involved with point-of-care ultrasound (POCUS) research and scholarship, and are leaders in both the POCUS program at their local site and within the national Canadian POCUS community. This 14-member expert group used a modified Delphi process consisting of three rounds of sequential surveys and discussion to achieve consensus on the top five most influential papers for FAST and E-FAST. Results The expert panel identified 56 relevant papers on FAST and 40 relevant papers on E-FAST. After completing all three rounds of the modified Delphi process, the authors identified the top five most influential papers on FAST and the top five most influential papers on E-FAST. Conclusion We have developed a reading list of the top five influential papers for FAST and E-FAST that will benefit residents, fellows, and clinicians who are interested in using POCUS in an evidence-informed manner.
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Chan AHY, Lee WF, Van Gerven PWM, Chenkin J. Assessment of changes in gaze patterns during training in point-of-care ultrasound. BMC MEDICAL EDUCATION 2022; 22:658. [PMID: 36056331 PMCID: PMC9440555 DOI: 10.1186/s12909-022-03680-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is a core skill in emergency medicine (EM), however, there is a lack of objective competency measures. Eye-tracking technology is a potentially useful assessment tool, as gaze patterns can reliably discriminate between experts and novices across medical specialties. We aim to determine if gaze metrics change in an independent and predictable manner during ultrasound training. METHODS A convenience sample of first-year residents from a single academic emergency department was recruited. Participants interpreted 16 ultrasound videos of the focused assessment with sonography for trauma (FAST) scan while their gaze patterns were recorded using a commercially available eye-tracking device. The intervention group then completed an introductory ultrasound course whereas the control group received no additional education. The gaze assessment was subsequently repeated. The primary outcome was total gaze duration on the area of interest (AOI). Secondary outcomes included time to fixation, mean duration of first fixation and mean number of fixations on the AOI. RESULTS 10 EM residents in the intervention group and 10 non-EM residents in the control group completed the study. After training, there was an 8.8 s increase in the total gaze time on the AOI in the intervention group compared to a 4.0 s decrease in the control group (p = .03). EM residents were also 3.8 s quicker to fixate on the AOI whereas the control group became 2.5 s slower (p = .04). There were no significant interactions on the number of fixations (0.43 vs. 0.18, p = .65) or duration of first fixation on the AOI (0.02 s vs. 0.06 s, p = .63). CONCLUSIONS There are significant and quantifiable changes in gaze metrics, which occur with incremental learning after an ultrasound course. Further research is needed to validate the serial use of eye-tracking technology in following a learner's progress toward competency in point-of-care ultrasound image interpretation.
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Affiliation(s)
- Alice H Y Chan
- Department of Emergency Medicine, Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Avenue, AG245, Toronto, ON, M4N 3M5, Canada.
| | - Wei Feng Lee
- Department of Emergency Medicine, Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Avenue, AG245, Toronto, ON, M4N 3M5, Canada
- Department of Emergency Medicine, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, Singapore, 609606
| | - Pascal W M Van Gerven
- Department of Educational Development and Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Jordan Chenkin
- Department of Emergency Medicine, Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Avenue, AG245, Toronto, ON, M4N 3M5, Canada
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Kim DJ, Olszynski P, Smith DJW, Lalande E, Woo MY. Point of care ultrasound training in Canadian emergency medicine residency programs. CAN J EMERG MED 2022; 24:329-334. [PMID: 35239169 DOI: 10.1007/s43678-022-00269-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/17/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVES Point of care ultrasound (POCUS) has been endorsed as an important clinical tool by the Canadian Association of Emergency Physicians (CAEP) and is a training objective of emergency medicine (EM) residency programs accredited by both the Royal College of Physicians and Surgeons of Canada (RCPSC) and the College of Family Physicians of Canada (CFPC). Our objectives are to describe the national state of POCUS training in RCPSC-EM and CFPC-EM residency programs and to evaluate the implementation of the CAEP core POCUS curriculum in these programs. METHODS This was an online survey study of all POCUS education leads for both RCPSC-EM and CFPC-EM programs. The survey queried participants on program demographics, description of POCUS training, methods of POCUS assessment, and implementation of the CAEP core POCUS curriculum. RESULTS The response rate was 100% (39/39). All RCPSC-EM and CFPC-EM programs provide POCUS training for their residents, and 100% of RCPSC-EM programs and 91% (20/22) of CFPC-EM programs have a POCUS lead. All programs provide POCUS training for their residents, but there is variability in how POCUS is introduced to residents, ongoing POCUS instruction provided throughout residency, and POCUS assessment. Only 47% (8/17) of RCPSC-EM and 32% (7/22) of CFPC-EM programs have a quality assurance process for the use of POCUS by their residents. POCUS leads believe their residents are proficient in the CAEP core POCUS applications by the end of training except for advanced cardiac and thoracic ultrasound. CONCLUSIONS POCUS training in Canadian EM programs is prevalent, but there is variability in support for POCUS leads, delivery of training, determination of proficiency, and presence of quality assurance. While almost all programs deliver POCUS education aligning with the CAEP core POCUS curriculum position statement, more support is required both locally and nationally for sharing best practices for POCUS education.
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Affiliation(s)
- Daniel J Kim
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada. .,Department of Emergency Medicine, Vancouver General Hospital, 855 12th Ave W, Vancouver, BC, V5Z 1M9, Canada.
| | - Paul Olszynski
- Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - David J W Smith
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Elizabeth Lalande
- Department of Emergency Medicine, Centre Hospitalier de l'Université Laval (CHUL), CHU de Québec, Université Laval, Québec, QC, Canada
| | - Michael Y Woo
- Department of Emergency Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Sheppard G, Devasahayam AJ, Campbell C, Najafizada M, Yi Y, Power A. The prevalence and patterns of use of point-of-care ultrasound in Newfoundland and Labrador. CANADIAN JOURNAL OF RURAL MEDICINE 2021; 26:160-168. [PMID: 34643555 DOI: 10.4103/cjrm.cjrm_61_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction Point-of-care ultrasound (POCUS) is used for diagnostic and procedural guidance by physicians in Newfoundland and Labrador (NL). POCUS use is largely limited to urban locations and the training is variable amongst physicians. The primary aim of this study was to determine the prevalence of POCUS devices in NL and the secondary aim was to characterise the patterns of POCUS use amongst physicians in NL. Methods This is a mixed-methods cross-sectional study. We determined the prevalence of POCUS devices from purchase records and the patterns of POCUS use through theme-based interviews. The interviews were transcribed, coded and analysed using standardised qualitative methods. Results Ten physicians (3 females, 5 rural) participated in the interviews. The overall prevalence of POCUS devices in NL was 12.5/100,000 population. Participants in urban areas had more access to POCUS training and devices. Participants used POCUS on a daily or weekly basis to rule in or out life-threatening conditions and improve access to specialist care. The benefits of POCUS included expedited investigations, decreased radiation and increased patient satisfaction. The barriers to using POCUS were lack of training, time, devices, image archiving software, difficulty generating and interpreting images and patient body habitus. Conclusion This is the first study to our knowledge to report the prevalence of POCUS devices in Canada. Physicians who practise in rural NL have limited access to POCUS devices and have identified barriers to POCUS training. Connecting physicians in rural areas with POCUS experts through a province-wide POCUS network may address these barriers and improve healthcare access.
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Affiliation(s)
- Gillian Sheppard
- Discipline of Emergency Medicine, Faculty of Medicine Memorial University, Canada
| | | | - Craig Campbell
- Medical Student with the Faculty of Medicine at Memorial Univeristy, Canada
| | - Maisam Najafizada
- Division of Community Health and Humanities, Faculty of Medicine Memorial University, Canada
| | - Yanqing Yi
- Division of Community Health and Humanities, Faculty of Medicine Memorial University, Canada
| | - Amanda Power
- Discipline of Emergency Medicine, Faculty of Medicine Memorial University, Canada
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Bell C, Wagner N, Hall A, Newbigging J, Rang L, McKaigney C. The ultrasound competency assessment tool for four-view cardiac POCUS. Ultrasound J 2021; 13:42. [PMID: 34570287 PMCID: PMC8476706 DOI: 10.1186/s13089-021-00237-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) has been recognized as an essential skill across medicine. However, a lack of reliable and streamlined POCUS assessment tools with demonstrated validity remains a significant barrier to widespread clinical integration. The ultrasound competency assessment tool (UCAT) was derived to be a simple, entrustment-based competency assessment tool applicable to multiple POCUS applications. When used to assess a FAST, the UCAT demonstrated high internal consistency and moderate-to-excellent inter-rater reliability. The objective of this study was to validate the UCAT for assessment of a four-view transthoracic cardiac POCUS. RESULTS Twenty-two trainees performed a four-view transthoracic cardiac POCUS in a simulated environment while being assessed by two observers. When used to assess a four-view cardiac POCUS the UCAT retained its high internal consistency ([Formula: see text] and moderate-to-excellent inter-rater reliability (ICCs = 0.61-0.91; p's ≤ 0.01) across all domains. The regression analysis suggestion that level of training, previous number of focused cardiac ultrasound, previous number of total scans, self-rated entrustment, and intent to pursue certification statistically significantly predicted UCAT entrustment scores [F (5,16) = 4.06, p = 0.01; R2 = 0.56]. CONCLUSION This study confirms the UCAT is a valid assessment tool for four-view transthoracic cardiac POCUS. The findings from this work and previous studies on the UCAT demonstrate the utility and flexibility of the UCAT tool across multiple POCUS applications and present a promising way forward for POCUS competency assessment.
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Affiliation(s)
- Colin Bell
- Department of Emergency Medicine & Cumming School of Medicine, Emergency Physician, Calgary Zone, Alberta Health Services, University of Calgary, 7007 14th St. SW, Calgary, AB, T2V1P9, Canada.
- Department of Emergency Medicine, Queen's University, 76 Stuart St Kingston, Kingston, ON, K7L2V7, Canada.
| | - Natalie Wagner
- Department of Biomedical & Molecular Sciences, Queen's University, 74 Union St Kingston, Kingston, ON, K7L3N6, Canada
| | - Andrew Hall
- Department of Emergency Medicine, Queen's University, 76 Stuart St Kingston, Kingston, ON, K7L2V7, Canada
- Office of Professional Development & Educational Scholarship, Queen's University, 68 Barrie St Kingston, Kingston, ON, K7L3N6, Canada
- Royal College of Physicians and Surgeons Canada, 774 Echo Drive, Ottawa, ON, K1S5N8, Canada
- Department of Emergency Medicine, The Ottawa Hospital and University of Ottawa, 1053 Carling Ave, E-Main, Room EM-206, Box 227, Ottawa, ON, K1Y4E9, Canada
| | - Joseph Newbigging
- Department of Emergency Medicine, Queen's University, 76 Stuart St Kingston, Kingston, ON, K7L2V7, Canada
| | - Louise Rang
- Department of Emergency Medicine, Queen's University, 76 Stuart St Kingston, Kingston, ON, K7L2V7, Canada
| | - Conor McKaigney
- Department of Emergency Medicine & Cumming School of Medicine, Emergency Physician, Calgary Zone, Alberta Health Services, University of Calgary, 7007 14th St. SW, Calgary, AB, T2V1P9, Canada
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Rusiecki D, Douglas SL, Bell C. Point-of-Care Ultrasound Use and Monetary Outcomes in a Single-Payer Health Care Setting. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1803-1809. [PMID: 33169875 DOI: 10.1002/jum.15560] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/21/2020] [Accepted: 10/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Point-of-care ultrasound (POCUS) is a widely used diagnostic modality in the emergency physician's tool kit. The effect on health care costs is disputed. This study examined whether POCUS was associated with system-level cost savings. Secondary objectives included adverse patient outcomes and the association between POCUS use and diagnostic costs in specific patient groups. METHODS The Point-of-Care Ultrasound Use and Monetary Outcomes study was a single-center prospective observational study. A convenience sample of emergency medicine physicians working from July to October 2019 were included after using POCUS as part of their assessment. The cost of patient investigations was compared with those proposed by a control group of physicians simultaneously on shift, who were blinded to the POCUS findings. Ethical approval was obtained from the Queen's University Health Sciences Research Ethics Board. RESULTS Fifty patient assessments using POCUS were included. Overall, the median investigation cost in United States dollars in the POCUS group was $102.00 (interquartile range [IQR], $39.80-$167.90) versus $122.40 (IQR, $70.96-$175.60) in controls (P = .08). When stratified by disposition, POCUS use in patients discharged home resulted in a median expenditure of $71.80 (IQR, $36.48-$116.70) versus $122.70 (IQR, $71.18-$183.20; P < .001). Significant cost savings were also found in flank pain presentations (median, $138.90; IQR, $136.60-$186.10; P = .01). There were no differences in the quantity of investigations ordered, the patient emergency department repeated presentation rate, or safety outcomes at 7 days. CONCLUSIONS Point-of-care ultrasound use was not associated with significant cost savings in our overall population. The subgroup analysis revealed significant POCUS-associated cost savings in patients discharged home and those presenting with flank pain. Notably, POCUS was not associated with an increase in adverse patient safety outcomes.
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Affiliation(s)
- Daniel Rusiecki
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Stuart L Douglas
- Departments of Emergency Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
- Critical Care Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Colin Bell
- Departments of Emergency Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
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Bell C, Hall AK, Wagner N, Rang L, Newbigging J, McKaigney C. The Ultrasound Competency Assessment Tool (UCAT): Development and Evaluation of a Novel Competency-based Assessment Tool for Point-of-care Ultrasound. AEM EDUCATION AND TRAINING 2021; 5:e10520. [PMID: 34041429 PMCID: PMC8138101 DOI: 10.1002/aet2.10520] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/15/2020] [Accepted: 08/09/2020] [Indexed: 05/09/2023]
Abstract
OBJECTIVES Point-of-care ultrasound (POCUS) has become an integral diagnostic and interventional tool. Barriers to POCUS training persist, and it continues to remain heterogeneous across training programs. Structured POCUS assessment tools exist, but remain limited in their feasibility, acceptability, reliability, and validity; none of these tools are entrustment-based. The objective of this study was to derive a simple, entrustment-based POCUS competency assessment tool and pilot it in an assessment setting. METHODS This study was composed of two phases. First, a three-step modified Delphi design surveyed 60 members of the Canadian Association of Emergency Physicians Emergency Ultrasound Committee (EUC) to derive the anchors for the tool. Subsequently, the derived ultrasound competency assessment tool (UCAT) was used to assess trainee (N = 37) performance on a simulated FAST examination. The intraclass correlation (ICC) for inter-rater reliability and Cronbach's alpha for internal consistency were calculated. A statistical analysis was performed to compare the UCAT to other competency surrogates. RESULTS The three-round Delphi had 22, 26, and 26 responses from the EUC members. Consensus was reached, and anchors for the domains of preparation, image acquisition, image optimization, and clinical integration achieved approval rates between 92 and 96%. The UCAT pilot revealed excellent inter-rater reliability (with ICC values of 0.69-0.89; p < 0.01) and high internal consistency (α = 0.91). While UCAT scores were not impacted by level of training, they were significantly impacted by the number of previous POCUS studies completed. CONCLUSIONS We developed and successfully piloted the UCAT, an entrustment-based bedside POCUS competency assessment tool suitable for rapid deployment. The findings from this study indicate early validity evidence for the use of the UCAT as an assessment of trainee POCUS competence on FAST. The UCAT should be trialed in different populations performing several POCUS study types.
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Affiliation(s)
- Colin Bell
- Department of Emergency MedicineQueen's UniversityKingstonOntarioCanada
| | - Andrew K. Hall
- Department of Emergency MedicineQueen's UniversityKingstonOntarioCanada
| | - Natalie Wagner
- Department of Biomedical & Molecular SciencesQueen's UniversityKingstonOntarioCanada
- Office of Professional Development & Educational ScholarshipQueen's UniversityKingstonOntarioCanada
| | - Louise Rang
- Department of Emergency MedicineQueen's UniversityKingstonOntarioCanada
| | - Joseph Newbigging
- Department of Emergency MedicineQueen's UniversityKingstonOntarioCanada
| | - Conor McKaigney
- Department of Emergency MedicineUniversity of CalgaryCalgaryAlbertaCanada
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Schonnop R, Stauffer B, Gauri A, Ha D. Procedural Skills Training in Emergency Medicine Physicians Within the Edmonton Zone: A Needs Assessment. AEM EDUCATION AND TRAINING 2021; 5:e10495. [PMID: 33842810 PMCID: PMC8019211 DOI: 10.1002/aet2.10495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The objectives were to describe the current procedural skill practices, attitudes toward procedural skill competency, and the role for educational skills training sessions among emergency medicine (EM) physicians within a geographic health zone. METHODS This is a multicenter descriptive cross-sectional survey of all EM physicians working at 12 emergency departments (EDs) within the Edmonton Zone in 2019. Survey items addressed current procedural skill performance frequency; perceived importance and confidence; current methods to maintain competence; barriers and facilitating factors to participation in a curriculum; preferred teaching methods; and desired frequency of practice for each procedural skill. RESULTS Survey response rate was 53.6%. Variability in frequency of performed procedures was seen across the type of hospital sites. For the majority of skills, there was a significantly positive correlation between the frequency at which a skill was performed and the perceived confidence performing said skill. There was inconsistency and no significant correlation with perceived importance, perceived confidence or frequency performing a given skill, and the desired frequency of training for that skill. Course availability (76.2%) and time (72.8%) are the most common identified barriers to participation in procedural skills training. CONCLUSIONS This study summarized the current ED procedural skill practices among EM physicians in the Edmonton Zone and attitudes toward an educational curriculum for procedural skill competency. This represents a step toward targeted continuing professional development in staff physicians.
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Affiliation(s)
- Rebecca Schonnop
- From theDepartment of Emergency MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Brandy Stauffer
- From theDepartment of Emergency MedicineUniversity of AlbertaEdmontonAlbertaCanada
- and theDepartment of Emergency Medicine & Department of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
| | - Aliyah Gauri
- From theDepartment of Emergency MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - David Ha
- From theDepartment of Emergency MedicineUniversity of AlbertaEdmontonAlbertaCanada
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Bell CR, Szulewski A, Walker M, McKaigney C, Ross G, Rang L, Newbigging J, Kendall J. Differences in Gaze Fixation Location and Duration Between Resident and Fellowship Sonographers Interpreting a Focused Assessment With Sonography in Trauma. AEM EDUCATION AND TRAINING 2021; 5:28-36. [PMID: 33521488 PMCID: PMC7821074 DOI: 10.1002/aet2.10439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/22/2020] [Accepted: 02/07/2020] [Indexed: 05/30/2023]
Abstract
OBJECTIVES We quantified the gaze fixation duration of resident and fellowship sonographers interpreting a prerecorded focused assessment with sonography in trauma (FAST). We hypothesized that all sonographers would fixate on each relevant anatomic relationship but that the duration of fixation would differ. METHODS We conducted a cross-sectional study collecting and analyzing the gaze fixations of a convenience sample of current resident and fellowship sonographers. All sonographers viewed a standardized FAST video, and their gaze fixations were recorded using a Tobii X3-120 eye-tracking bar. Gaze fixations over nine anatomic regions of interest (ROIs) were identified. These were assessed for normality and analyzed using the Wilcoxon rank sum test at an alpha of 0.05 and Bonferroni correction p value of <0.0034. The chi-square test and Pearson's correlation were performed to assess statistical association. RESULTS The gaze fixation recordings of 24 resident and eight fellowship sonographers were suitable for analysis. Fourteen of the 24 resident sonographers viewed all ROIs in the FAST, whereas all eight fellowship sonographers viewed each of the nine relevant ROIs. Five ROIs were identified over which at least one resident sonographer did not have a gaze fixation. No statistically significant difference was identified between groups. Resident sonographers gaze fixated over the left upper quadrant (LUQ) splenorenal interface for a median (interquartile range) of 10.64 (9.73-11.60) seconds. The fellowship group viewed the same ROI for 8.43 (6.64-8.95) seconds (p < 0.003). All participants viewed this ROI. No other ROIs had a statistical difference. CONCLUSION Five ROIs were identified that were not visually interrogated by all resident sonographers. Only 14 of 24 resident sonographers visually interrogated every area in the FAST, whereas all fellowship sonographers interrogated every ROI. A statistically significant difference was found in gaze fixation duration between resident and fellowship sonographers in one ROI. Further study is required for gaze fixation assessment to become a tool for the interpretation component of point-of-care ultrasound.
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Affiliation(s)
- Colin R. Bell
- Department of Emergency MedicineKingston Health Sciences CentreKingstonOntario
- Queen’s University School of MedicineKingstonOntario
| | - Adam Szulewski
- Department of Emergency MedicineKingston Health Sciences CentreKingstonOntario
- Queen’s University School of MedicineKingstonOntario
| | - Melanie Walker
- Department of Emergency MedicineKingston Health Sciences CentreKingstonOntario
| | - Conor McKaigney
- Department of Emergency MedicineSouth Health, Alberta Health Services and Cumming School of Medicine at the University of CalgaryCalgaryAlbertaCanada
| | - Graeme Ross
- Department of Emergency MedicineKingston Health Sciences CentreKingstonOntario
- Queen’s University School of MedicineKingstonOntario
| | - Louise Rang
- Department of Emergency MedicineKingston Health Sciences CentreKingstonOntario
- Queen’s University School of MedicineKingstonOntario
| | - Joseph Newbigging
- Department of Emergency MedicineKingston Health Sciences CentreKingstonOntario
- Queen’s University School of MedicineKingstonOntario
| | - John Kendall
- Department of Emergency MedicineDenver Health Medical Center and University of Colorado Medical SchoolDenverCO
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Prehospital ultrasound use among Canadian aeromedical service providers - A cross-sectional survey. CAN J EMERG MED 2019; 22:338-341. [PMID: 31813395 DOI: 10.1017/cem.2019.451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Evidence suggests that prehospital point of care ultrasound (POCUS) may change patient management. It serves as an aid in triage, physical examination, diagnosis, and patient disposition. The rate of adoption of POCUS among aeromedical services throughout Canada is unknown. The objective of this study was to describe current POCUS use among Canadian aeromedical services providers. METHODS This is a cross-sectional observational study. A survey was emailed to directors of government-funded aeromedical services bases in Canada. Data were analyzed using descriptive statistics. RESULTS The response rate was 82.3% (14/17 aeromedical services directors), representing 41 of 46 individual bases. POCUS is used by aeromedical services in British Columbia, Alberta, Saskatchewan, and Manitoba. New Brunswick, Nova Scotia, Prince Edward Island, and Yukon reported they are planning to introduce POCUS within the next year. Ontario and Newfoundland reported they are not using POCUS and are not planning to introduce it. British Columbia is the only province currently using POCUS on fixed-wing aircraft. Most commonly reported frequency of POCUS use on missions was <25%. Most useful applications are assessment for pneumothorax, abdominal free fluid, and cardiac standstill. The most common barrier to POCUS use is cost of training and maintenance of competence. CONCLUSIONS Prehospital POCUS is available in Western Canada with one third of the Canadian population having access to aeromedical services using ultrasound. The Maritimes and the Yukon Territory will further extend POCUS use on fixed-wing aircraft. While there are barriers to POCUS use, those bases that have adopted POCUS consider it valuable.
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Does point-of-care ultrasonography improve clinical outcomes in emergency department patients with undifferentiated hypotension? CAN J EMERG MED 2019; 21:593-594. [DOI: 10.1017/cem.2019.346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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