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Sinanan R, Moshtaghi A, Koratala A. Point-of-care ultrasound in nephrology: A private practice viewpoint. World J Methodol 2024; 14:95685. [DOI: 10.5662/wjm.v14.i4.95685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/28/2024] [Accepted: 07/05/2024] [Indexed: 07/26/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is a limited ultrasound examination performed by the clinician at the bedside, emerging as a complement to physical examination across various medical specialties. In the field of nephrology, its integration has been gradual, primarily limited to guiding procedures like temporary dialysis catheter placement or, in some cases, diagnostic kidney ultrasounds. In reality, the assessment of hemodynamic status at the bedside holds immense value for nephrologists, yet there exists limited awareness among practitioners regarding its implementation. While there is a growing trend towards incorporating multi-organ POCUS training in fellowship programs, private practice nephrologists remain relatively uninformed. This discussion explores the untapped potential of POCUS as a valuable diagnostic tool in everyday nephrology practice, demonstrating its effectiveness in diverse clinical settings, ranging from medical wards to outpatient dialysis units. Additionally, we delve into the challenges hindering its widespread adoption and consider the future trajectory of this innovative approach.
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Affiliation(s)
- Rajiv Sinanan
- Arizona Kidney Disease and Hypertension Centers, Phoenix, AZ 85016, United States
| | - Afsheen Moshtaghi
- Department of Medicine, Verde Valley Medical Center, Cottonwood, AZ 86326, United States
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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Baker DR, Glau CL, Himebauch AS, Arnoldi S, Rosenblatt S, Keim G, Loscalzo SM, Weber MD, Cohen M, Quartermain MD, Kaplan SL, Sutton RM, Nishisaki A, Conlon TW. Evolution and Impact of a Diagnostic Point-of-Care Ultrasound Program in a PICU. Pediatr Crit Care Med 2024:00130478-990000000-00366. [PMID: 39023322 DOI: 10.1097/pcc.0000000000003581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
OBJECTIVES To evaluate the impact of point-of-care ultrasound (POCUS) use on clinicians within a PICU and to assess infrastructural elements of our POCUS program development. DESIGN Retrospective observational study. SETTING Large academic, noncardiac PICU in the United States. SUBJECTS Patients in a PICU who had diagnostic POCUS performed. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Between January 1, 2017, and December 31, 2022, 7201 diagnostic POCUS studies were ordered; 1930 (26.8%) had a quality assurance (QA) record generated in an independent POCUS QA database. The cardiac domain was most frequently imaged (81.0% of ordered studies, 81.2% of reviewed studies). POCUS images changed clinician understanding of pathophysiology in 563 of 1930 cases (29.2%); when this occurred, management was changed in 318 of 563 cases (56.5%). Cardiac POCUS studies altered clinician suspected pathophysiology in 30.1% of cases (472/1568), compared with 21.5% (91/362) in noncardiac studies (p = 0.06). Among cases where POCUS changed clinician understanding, management changed more often following cardiac than noncardiac POCUS (p = 0.02). Clinicians identified a need for cardiology consultation or complete echocardiograms in 294 of 1568 cardiac POCUS studies (18.8%). Orders for POCUS imaging increased by 94.9%, and revenue increased by 159.4%, from initial to final study year. QA database use by both clinicians and reviewers decreased annually as QA processes evolved in the setting of technologic growth and unit expansion. CONCLUSIONS Diagnostic POCUS imaging in the PICU frequently yields information that alters diagnosis and changes management. As PICU POCUS use increased, QA processes evolved resulting in decreased use of our initial QA database. Modifications to QA processes are likely necessary as clinical contexts change over time.
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Affiliation(s)
- David R Baker
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Christie L Glau
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Adam S Himebauch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sara Arnoldi
- Department of Paediatric Anaesthesia, Evelina London Children's Hospital, London, United Kingdom
| | - Sam Rosenblatt
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Garrett Keim
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Steven M Loscalzo
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Mark D Weber
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Meryl Cohen
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Michael D Quartermain
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Summer L Kaplan
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Robert M Sutton
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Thomas W Conlon
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
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Musolino AM, Tei M, De Rose C, Buonsenso D, Supino MC, Zampogna S, Staiano A, Raponi M, Amendolea A, Colacino V, Gori L, Manganaro A, Ricci R, D'Inzeo V, Grosso S, Villani A, Agostiniani R. Pediatric ultrasound practice in Italy: an exploratory survey. Ital J Pediatr 2024; 50:114. [PMID: 38853266 PMCID: PMC11163714 DOI: 10.1186/s13052-024-01680-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 05/25/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND The aim of this exploratory survey is to describe the current state of US (ultrasound) technique across different pediatric settings nationwide. METHODS A questionnaire was emailed to all members of the Italian Society of Pediatrics, including pediatric residents. The survey was open from December 2021 to March 2022. RESULTS There were 1098 respondents. Seven hundred and seven pediatricians (84.1%) reported any use of US, while 51 (44.3%) residents denied it. The majority of participants (n = 956, 87.1%) reported to have a US machine available within the department, mostly cart-based (n = 516, 66.9%) and provided from 1 to 5 years prior to the survey (n = 330, 42.8%). Lung and neonatal cerebral regions were the most frequently scanned (n = 289, 18.7% and n = 218, 14.1%, respectively). The suspicion of pneumonia or respiratory distress represented the main reasons for performing US in emergency room (n = 390, 78% and n = 330, 66%, respectively). The majority of family pediatricians reported to scan lung and kidney/urinary tract regions (n = 30, 16.9%, and n = 23,12.9%, respectively). Regarding US training, the majority of respondents (n = 358, 34.6%) declared an experience-based education, with a deficient certification enabling the use of US in 71.6% (n = 552) of cases. The most common barriers included the lack of a well-defined training program (n = 627, 57.1%), unavailability of the US machine (n = 196, 17.9%) and legal responsibility concern (n = 175, 15.9%). CONCLUSIONS Despite the growing interest on pediatric US nationally, significant barriers still limit widespread adoption. These obstacles may be addressed through the dissemination of a specific US education plan and providing additional resources.
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Affiliation(s)
- Anna Maria Musolino
- Unit of Emergency Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Monica Tei
- Clinical Pediatrics, Department of Mother and Child, Siena University Hospital, Viale Bracci 16, Siena, 53100, Italy.
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Supino
- Unit of Emergency Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Stefania Zampogna
- Department Pediatrics, Hospital of Crotone President of SIMEUP (Italian Society of Pediatric Emergency Medicine Urgency), Crotone, Italy
| | - Annamaria Staiano
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", President of SIP (Italian Society of Pediatric), Naples, Italy
| | - Massimiliano Raponi
- Management and Diagnostic Innovations and Clinical Pathways Research Area, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, 00165, Italy
| | | | | | - Laura Gori
- Department of Maternal and Child Health, Santa Chiara Hospital, University of Pisa, Pisa, 56100, Italy
| | - Alessandro Manganaro
- Pathology and Neonatal and Pediatric Intensive Care Unit, University Hospital G. Martino, Messina, Italy
| | - Riccardo Ricci
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Victoria D'Inzeo
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Department of Mother and Child, Siena University Hospital, Viale Bracci 16, Siena, 53100, Italy
| | - Alberto Villani
- Unit of General Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Rino Agostiniani
- Department of Pediatrics and Neonatology, San Jacopo Hospital, Via Ciliegiole 97, 51100, Pistoia, Italy
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Boyd SM, Kluckow M, McNamara PJ. Targeted Neonatal Echocardiography in the Management of Neonatal Pulmonary Hypertension. Clin Perinatol 2024; 51:45-76. [PMID: 38325947 DOI: 10.1016/j.clp.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Pulmonary hypertension (PH) in neonates, originating from a range of disease states with heterogeneous underlying pathophysiology, is associated with significant morbidity and mortality. Although the final common pathway is a state of high right ventricular afterload leading to compromised cardiac output, multiple hemodynamic phenotypes exist in acute and chronic PH, for which cardiorespiratory treatment strategies differ. Comprehensive appraisal of pulmonary pressure, pulmonary vascular resistance, cardiac function, pulmonary and systemic blood flow, and extrapulmonary shunts facilitates delivery of individualized cardiovascular therapies in affected newborns.
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Affiliation(s)
- Stephanie M Boyd
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Corner Hawkesbury Road, Hainsworth Street, Westmead, Sydney 2145, Australia; The University of Sydney, Sydney, Australia
| | - Martin Kluckow
- The University of Sydney, Sydney, Australia; Department of Neonatology, Royal North Shore Hospital, Reserve Road, St Leonards 2065, Sydney, Australia
| | - Patrick J McNamara
- Division of Neonatology, The University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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Prager R, Wu D, Garber G, Finestone PJ, Zang C, Aslanova R, Arntfield R. Medico-legal risks of point-of-care ultrasound: a closed-case analysis of Canadian Medical Protective Association medico-legal cases. Ultrasound J 2024; 16:16. [PMID: 38396310 PMCID: PMC10891006 DOI: 10.1186/s13089-024-00364-7] [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: 07/25/2023] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) has become a core diagnostic tool for many physicians due to its portability, excellent safety profile, and diagnostic utility. Despite its growing use, the potential risks of POCUS use should be considered by providers. We analyzed the Canadian Medical Protective Association (CMPA) repository to identify medico-legal cases arising from the use of POCUS. METHODS We retrospectively searched the CMPA closed-case repository for cases involving diagnostic POCUS between January 1st, 2012 and December 31st, 2021. Cases included civil-legal actions, medical regulatory authority (College) cases, and hospital complaints. Patient and physician demographics, outcomes, reason for complaint, and expert-identified contributing factors were analyzed. RESULTS From 2012 to 2021, there were 58,626 closed medico-legal cases in the CMPA repository with POCUS determined to be a contributing factor for medico-legal action in 15 cases; in all cases the medico-legal outcome was decided against the physicians. The most common reasons for patient complaints were diagnostic error, deficient assessment, and failure to perform a test or intervention. Expert analysis of these cases determined the most common contributing factors for medico-legal action was failure to perform POCUS when indicated (7 cases, 47%); however, medico-legal action also resulted from diagnostic error, incorrect sonographic approach, deficient assessment, inadequate skill, inadequate documentation, or inadequate reporting. CONCLUSIONS Although the most common reason associated with the medico-legal action in these cases is failure to perform POCUS when indicated, inappropriate use of POCUS may lead to medico-legal action. Due to limitations in granularity of data, the exact number of civil-legal, College cases, and hospital complaints for each contributing factor is unavailable. To enhance patient care and mitigate risk for providers, POCUS should be carefully integrated with other clinical information, performed by providers with adequate skill, and carefully documented.
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Affiliation(s)
- Ross Prager
- Division of Critical Care, Western University, London, Ontario, Canada.
- London Health Sciences Centre, Rm # D2-528, 800 Commissioners Rd. E., London, ON, N6A 5W9, Canada.
| | - Derek Wu
- Department of Medicine, Western University, London, Ontario, Canada
| | - Gary Garber
- Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - P J Finestone
- Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Cathy Zang
- Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Rana Aslanova
- Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Robert Arntfield
- Division of Critical Care, Western University, London, Ontario, Canada
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Koratala A, Kazory A. Seeing through the myths: Practical aspects of diagnostic point-of-care ultrasound in nephrology. World J Nephrol 2023; 12:112-119. [PMID: 38230300 PMCID: PMC10789085 DOI: 10.5527/wjn.v12.i5.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/16/2023] [Accepted: 11/08/2023] [Indexed: 12/22/2023] Open
Abstract
Point of care ultrasonography (POCUS) is emerging as an invaluable tool for guiding patient care at the bedside, providing real-time diagnostic information to clinicians. Today, POCUS is recognized as the fifth pillar of bedside clinical examination, alongside inspection, palpation, percussion, and auscultation. In spite of growing interest, the adoption of diagnostic POCUS in nephrology remains limited, and comprehensive training beyond kidney ultrasound is offered in only a few fellowship programs. Moreover, several misconceptions and barriers surround the integration of POCUS into day-to-day nephrology practice. These include myths about its scope, utility, impact on patient outcomes and legal implications. In this minireview, we address some of these issues to encourage wider and proper utilization of POCUS.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Wauwatosa, WI 53226, United States
| | - Amir Kazory
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL 32610, United States
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7
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Solomon L, Emma M, Gibbons LM, Kusulas MP. Current risk landscape of point-of-care ultrasound in pediatric emergency medicine in medical malpractice litigation. Am J Emerg Med 2022; 58:16-21. [PMID: 35623178 DOI: 10.1016/j.ajem.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound (PoCUS) is expanding as a diagnostic tool in pediatric emergency medicine. Pediatricians are apprehensive to take on the risk of malpractice from incorrect interpretation of PoCUS imaging, therefore limiting its use. Although current studies provide reassurance to this concern, none look directly at the risk for pediatric emergency medicine physicians. Our study aims to evaluate the current medicolegal risk landscape posed by PoCUS in pediatric emergency medicine. METHODS A search of case law was performed utilizing the LexisNexis caselaw database for the period of January 2011 through December 2021. Initial search results were reviewed by the attorney co-authors for relevance to medical malpractice surrounding PoCUS. The remaining cases were reviewed by physician co-authors to ensure their relevance to both ultrasound and the acute care setting. Identified cases were then classified into categories as per the reason for the claim. RESULTS No cases of malpractice litigation were identified that directly related to PoCUS. Ten cases of ultrasound in the acute care setting were identified, 7 of which were in pediatric patients. The majority of these cases related to appendicitis or testicular torsion. Of these 10 cases, 2 cases claimed failure to consider the ultimate diagnosis, but ultrasound would have been an appropriate study had the diagnosis been considered. Of the 8 remaining cases, 6 were based on failure to perform or delay performing ultrasound, 1 claimed that improper ultrasound study was initially performed, and 1 case was based on an improper diagnosis made by ultrasound. DISCUSSION PoCUS does not appear to pose a significant risk of malpractice litigation in pediatric emergency medicine.
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Affiliation(s)
- Linda Solomon
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States of America.
| | - Maggie Emma
- Risk Management, Northwell Health, New Hyde Park, NY, United States of America
| | - Lisa M Gibbons
- Claims Management, Northwell Health, Great Neck, NY, United States of America
| | - Matthew P Kusulas
- Departments of Pediatrics and Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America
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Establishing a risk assessment framework for point-of-care ultrasound. Eur J Pediatr 2022; 181:1449-1457. [PMID: 34846557 PMCID: PMC8964607 DOI: 10.1007/s00431-021-04324-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
UNLABELLED Point-of-care ultrasound (POCUS) refers to the use of portable ultrasound (US) applications at the bedside, performed directly by the treating physician, for either diagnostic or procedure guidance purposes. It is being rapidly adopted by traditionally non-imaging medical specialties across the globe. Recent international evidence-based guidelines on POCUS for critically ill neonates and children were issued by the POCUS Working Group of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC). Currently there are no standardized national or international guidelines for its implementation into clinical practice or even the training curriculum to monitor quality assurance. Further, there are no definitions or methods of POCUS competency measurement across its varied clinical applications. CONCLUSION The Hippocratic Oath suggests medical providers do no harm to their patients. In our continued quest to uphold this value, providers seeking solutions to clinical problems must often weigh the benefit of an intervention with the risk of harm to the patient. Technologies to guide diagnosis and medical management present unique considerations when assessing possible risk to the patient. Frequently risk extends beyond the patient and impacts providers and the institutions in which they practice. POCUS is an emerging technology increasingly incorporated in the care of children across varied clinical specialties. Concerns have been raised by clinical colleagues and regulatory agencies regarding appropriate POCUS use and oversight. We present a framework for assessing the risk of POCUS use in pediatrics and suggest methods of mitigating risk to optimize safety and outcomes for patients, providers, and institutions. WHAT IS KNOWN • The use POCUS by traditionally non-imaging pediatric specialty physicians for both diagnostic and procedural guidance is rapidly increasing. • Although there are international guidelines for its indications, currently there is no standardized guidance on its implementation in clinical practice. WHAT IS NEW • Although standards for pediatric specialty-specific POCUS curriculum and training to competency have not been defined, POCUS is likely to be most successfully incorporated in clinical care when programmatic infrastructural elements are present. • Risk assessment is a forward-thinking process and requires an imprecise calculus that integrates considerations of the technology, the provider, and the context in which medical care is delivered. Medicolegal considerations vary across countries and frequently change, requiring providers and institutions to understand local regulatory requirements and legal frameworks to mitigate the potential risks of POCUS.
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Koratala A, Olaoye OA, Bhasin-Chhabra B, Kazory A. A Blueprint for an Integrated Point-of-Care Ultrasound Curriculum for Nephrology Trainees. KIDNEY360 2021; 2:1669-1676. [PMID: 35372975 PMCID: PMC8785780 DOI: 10.34067/kid.0005082021] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/13/2021] [Indexed: 02/04/2023]
Abstract
Point-of-care ultrasonography (POCUS) is a limited ultrasound study performed by the clinician at the bedside as a component or an adjunct to physical examination. POCUS has multiple applications in nephrology practice, including evaluation of obstructive uropathy, objective assessment of volume status, arteriovenous access assessment, and procedural guidance. However, unlike specialties such as emergency medicine, POCUS training is not yet integrated into most nephrology fellowship curricula, and the sonographic applications taught vary widely among fellowship programs. In this article, we have used our institutional experience to provide a roadmap or blueprint for nephrology programs looking to create a POCUS program. We provide an overview of the curriculum, including the basic organization, applications taught, online resources, milestone development, and quality assessment. We also discuss the nuances of POCUS workflow and perspectives on billing for these limited studies. In addition, we share the evaluation forms and sample documentation we use in our program. Future support, in the form of endorsed nephrology society guidelines, is needed before POCUS training is universally incorporated across nephrology fellowship programs.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Olanrewaju A. Olaoye
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, Florida
| | | | - Amir Kazory
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, Florida
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Koratala A, Reisinger N. POCUS for Nephrologists: Basic Principles and a General Approach. KIDNEY360 2021; 2:1660-1668. [PMID: 35372985 PMCID: PMC8785785 DOI: 10.34067/kid.0002482021] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/04/2021] [Indexed: 02/04/2023]
Abstract
Point-of-care ultrasonography (POCUS) has evolved as a valuable adjunct to physical examination in the recent past and various medical specialties have embraced it. However, POCUS training and scope of practice remain relatively undefined in nephrology. The utility of diagnostic POCUS beyond kidney and vascular access is under-recognized. Assessment of fluid status is a frequent dilemma faced by nephrologists in day-to-day practice where multiorgan POCUS can enhance the sensitivity of conventional physical examination. POCUS also reduces fragmentation of care, facilitates timely diagnosis, and expedites management. Although the need for further imaging studies is obviated in selected patients, POCUS is not meant to serve as an alternative to consultative imaging. In addition, the utility of POCUS depends on the skills and experience of the operator, which in turn depend on the quality of training. In this review, we discuss the rationale behind nephrologists performing POCUS, discuss patient examples to illustrate the basic principles of focused ultrasonography, and share our experience-based opinion about developing a POCUS training program at the institutional level.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nathaniel Reisinger
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, Pennsylvania
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Kurepa D, Boyar V, Zaghloul N, Beachy J, Zaytseva A, Teng D, Cooper R, Klewer S, Amodio J. Structured Neonatal Point-of-Care Ultrasound Training Program. Am J Perinatol 2021; 38:e284-e291. [PMID: 32344442 DOI: 10.1055/s-0040-1709667] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Point-of-care ultrasound (POC US) has been increasingly used by intensive care physicians. Growing use of POC US necessitates defining distinct clinical indications for its application, as well as structured POC US training programs. Homogeneous approach to POC US education combined with rigorous quality assurance should further enable POC US to become standard-of-care clinical tool. This study aimed to present the first, innovative, and structured POC US program in neonatal-perinatal medicine field. In addition, we reviewed the availability of the POC US training programs across different medical specialties. STUDY DESIGN Available English-language publications on POC US training programs in general and neonatal-perinatal medicine were reviewed in this study. DISCUSSION Mounting body of evidence suggests improved procedural completion rates, as well as clinical decision making with the use of POC US. However, limited research supported the existence of structured, comprehensive POC US programs. It was recognized that medical institutions need to develop syllabuses, teach, and credential increasing number of health care professionals in the use of POC US. We defined intuitive educational strategy that encompasses POC US clinical indications, educational curriculum, scanning protocols, competence evaluation, and finally credentialing process. In addition, we offered description of the imaging quality assurance, as well as POC US coding, and reimbursement. CONCLUSION Future efforts need to be dedicated to the ongoing development of neonatal POC US as a clinical instrument. It should allow for eventual paradigm change and improved effectiveness in management of critically ill neonates.
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Affiliation(s)
- Dalibor Kurepa
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - Vitalya Boyar
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - Nahla Zaghloul
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Arizona, Tucson, Arizona
| | - Joanna Beachy
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - Alla Zaytseva
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - David Teng
- Division of Emergency Medicine, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - Rubin Cooper
- Division of Cardiology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - Scott Klewer
- Division of Cardiology, Department of Pediatrics, University of Arizona, Tucson, Arizona
| | - John Amodio
- Division of Radiology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
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12
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van Wassenaer EA, Daams JG, Benninga MA, Rosendahl K, Koot BGP, Stafrace S, Arthurs OJ, van Rijn RR. Non-radiologist-performed abdominal point-of-care ultrasonography in paediatrics - a scoping review. Pediatr Radiol 2021; 51:1386-1399. [PMID: 33837798 PMCID: PMC8266706 DOI: 10.1007/s00247-021-04997-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/06/2020] [Accepted: 02/03/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Historically, US in the paediatric setting has mostly been the domain of radiologists. However, in the last decade, there has been an uptake of non-radiologist point-of-care US. OBJECTIVE To gain an overview of abdominal non-radiologist point-of-care US in paediatrics. MATERIALS AND METHODS We conducted a scoping review regarding the uses of abdominal non-radiologist point-of-care US, quality of examinations and training, patient perspective, financial costs and legal consequences following the use of non-radiologist point-of-care US. We conducted an advanced search of the following databases: Medline, Embase and Web of Science Conference Proceedings. We included published original research studies describing abdominal non-radiologist point-of-care US in children. We limited studies to English-language articles from Western countries. RESULTS We found a total of 5,092 publications and selected 106 publications for inclusion: 39 studies and 51 case reports or case series on the state-of-art of abdominal non-radiologist point-of-care US, 14 on training of non-radiologists, and 1 each on possible harms following non-radiologist point-of-care US and patient satisfaction. According to included studies, non-radiologist point-of-care US is increasingly used, but no standardised training guidelines exist. We found no studies regarding the financial consequences of non-radiologist point-of-care US. CONCLUSION This scoping review supports the further development of non-radiologist point-of-care US and underlines the need for consensus on who can do which examination after which level of training among US performers. More research is needed on training non-radiologists and on the costs-to-benefits of non-radiologist point-of-care US.
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Affiliation(s)
- Elsa A van Wassenaer
- Emma Children's Hospital, Amsterdam UMC, Paediatric Gastroenterology, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands. .,Amsterdam Reproduction and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. .,Amsterdam Gastroenterology and Metabolism,Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Joost G Daams
- Amsterdam UMC, Medical Library, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc A Benninga
- Emma Children's Hospital, Amsterdam UMC, Paediatric Gastroenterology, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - Karen Rosendahl
- Department of Radiology, Section of Paediatric Radiology, University Hospital North Norway, Tromsø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Bart G P Koot
- Emma Children's Hospital, Amsterdam UMC, Paediatric Gastroenterology, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - Samuel Stafrace
- Division of Body imaging, Department of Diagnostic Imaging, Sidra Medicine and Weill Cornell Medicine, Doha, Qatar
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Biomedical Research Centre, London, UK
| | - Rick R van Rijn
- Amsterdam UMC, Radiology, University of Amsterdam, Amsterdam, The Netherlands
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13
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Koratala A, Kazory A. An Introduction to Point-of-Care Ultrasound: Laennec to Lichtenstein. Adv Chronic Kidney Dis 2021; 28:193-199. [PMID: 34906303 DOI: 10.1053/j.ackd.2021.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/26/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
Point-of-care ultrasonography (POCUS) is rapidly evolving as a noninvasive adjunct to physical examination among various specialties. POCUS increases the sensitivity of conventional physical examination by providing the answers to simple clinical questions at the bedside. As such, it can reduce fragmentation of care and expedite management. In addition, using bedside ultrasound as the first-line investigation may eliminate unnecessary radiation and contrast exposure. The advent of highly portable and affordable ultrasound devices has made the use of POCUS more practical and user-friendly, making it the stethoscope of the 21st century. This review will provide an overview of the rationale for integrating POCUS into nephrology practice. We also discuss the current scope of POCUS practice and state of training.
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Dversdal RK, Northcutt NM, Ferre RM. Building and Maintaining an Ultrasound Program: It Takes a Village. Adv Chronic Kidney Dis 2021; 28:236-243. [PMID: 34906308 DOI: 10.1053/j.ackd.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/27/2021] [Accepted: 06/09/2021] [Indexed: 12/23/2022]
Abstract
Building and maintaining a successful point-of-care ultrasound program is a complex process that involves establishing an ecosystem between three unique but overlapping domains: ultrasound equipment, ultrasound users, and the health care system. By highlighting the different areas of focus and each of the key stakeholders and components, a group can ensure adequate attention is paid to all aspects of point-of-care ultrasound program development in nephrology.
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15
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Su E, Soni NJ, Blaivas M, Bhargava V, Steffen K, Haileselassie B. Regulating Critical Care Ultrasound, It Is All in the Interpretation. Pediatr Crit Care Med 2021; 22:e253-e258. [PMID: 33060421 DOI: 10.1097/pcc.0000000000002600] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Point-of-care ultrasound (POCUS) use is rapidly expanding as a practice in adult and pediatric critical care environments. In January 2020, the Joint Commission endorsed a statement from the Emergency Care Research Institute citing point-of-care ultrasound as a potential hazard to patients for reasons related to training and skill verification, oversight of use, and recordkeeping and accountability mechanisms for clinical use; however, no evidence was presented to support these concerns. Existing data on point-of-care ultrasound practices in pediatric critical care settings verify that point-of-care ultrasound use continues to increase, and contrary to the concerns raised, resources are becoming increasingly available for point-of-care ultrasound use. Many institutions have recognized a successful approach to addressing these concerns that can be achieved through multispecialty collaborations.
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Affiliation(s)
- Erik Su
- Department of Pediatrics, McGovern Medical School, Houston, TX
| | - Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX
- Department of Medicine, University of Texas Health San Antonio, San Antonio, TX
| | - Michael Blaivas
- Department of Emergency Medicine, School of Medicine, University of South Carolina, St. Francis Hospital, Columbus, GA
- Department of Medicine, School of Medicine, University of South Carolina, St. Francis Hospital, Columbus, GA
| | - Vidit Bhargava
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Katherine Steffen
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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16
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Legal issues in Neonatologist Performed Echocardiography. The Italian experience. Pediatr Res 2020; 87:1140-1142. [PMID: 31837650 DOI: 10.1038/s41390-019-0721-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 11/21/2019] [Indexed: 11/08/2022]
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17
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Reaume M, Farishta M, Costello JA, Gibb T, Melgar TA. Analysis of lawsuits related to diagnostic errors from point-of-care ultrasound in internal medicine, paediatrics, family medicine and critical care in the USA. Postgrad Med J 2020; 97:55-58. [PMID: 32457206 DOI: 10.1136/postgradmedj-2020-137832] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study is to identify the extent of diagnostic error lawsuits related to point-of-care ultrasound (POCUS) in internal medicine, paediatrics, family medicine and critical care, of which little is known. METHODS We conducted a retrospective review of the Westlaw legal database for indexed state and federal lawsuits involving the diagnostic use of POCUS in internal medicine, paediatrics, family medicine and critical care. Retrieved cases were reviewed independently by three physicians to identify cases relevant to our study objective. A lawyer secondarily reviewed any cases with discrepancies between the three reviewers. RESULTS Our search criteria returned 131 total cases. Ultrasound was mentioned in relation to the lawsuit claim in 70 of the cases returned. In these cases, the majority were formal ultrasounds performed and reviewed by the radiology department, echocardiography studies performed by cardiologists or obstetrical ultrasounds. There were no cases of internal medicine, paediatrics, family medicine or critical care physicians being subjected to adverse legal action for their diagnostic use of POCUS. CONCLUSION Our results suggest that concerns regarding the potential for lawsuits related to POCUS in the fields of internal medicine, paediatrics, family medicine and critical care are not substantiated by indexed state and federal filed lawsuits.
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Affiliation(s)
- Michael Reaume
- Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mehdi Farishta
- Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Joseph A Costello
- Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Tyler Gibb
- Department of Medical Ethics-Humanities and Law, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Thomas A Melgar
- Pediatrics, Adolescent and Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
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18
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Breast cancer malpractice litigation: A 10-year analysis and update in trends. Clin Imaging 2020; 60:26-32. [DOI: 10.1016/j.clinimag.2019.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/30/2019] [Accepted: 12/02/2019] [Indexed: 12/21/2022]
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Abstract
Point-of-care, or clinician-performed ultrasound (CPU), is increasingly utilised within neonatology as a valuable adjunct to clinical examination. The ability to perform and interpret rapid, real-time, serial assessment of patient physiology at the bedside has seen the potential uses of CPU expand, with an evolving list of clinical and research applications. Benefits of functional assessment of neonatal haemodynamics in particular have been described across a range of gestational ages and disease states. Devising suitable curricula for trainees and ensuring robust processes for the training and credentialing of clinicians performing CPU is essential. Challenges to universal implementation of CPU in the neonatal intensive care setting exist, and regional differences in training and accreditation are well described. Appropriate integration into clinical decision-making and ensuring competency-based locally appropriate training programs, which build on an expanding evidence base, are key priorities in ensuring newborns receive optimal benefit from the modality.
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20
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Conlon TW, Nishisaki A, Singh Y, Bhombal S, De Luca D, Kessler DO, Su ER, Chen AE, Fraga MV. Moving Beyond the Stethoscope: Diagnostic Point-of-Care Ultrasound in Pediatric Practice. Pediatrics 2019; 144:peds.2019-1402. [PMID: 31481415 DOI: 10.1542/peds.2019-1402] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 11/24/2022] Open
Abstract
Diagnostic point-of-care ultrasound (POCUS) is a growing field across all disciplines of pediatric practice. Machine accessibility and portability will only continue to grow, thus increasing exposure to this technology for both providers and patients. Individuals seeking training in POCUS should first identify their scope of practice to determine appropriate applications within their clinical setting, a few of which are discussed within this article. Efforts to build standardized POCUS infrastructure within specialties and institutions are ongoing with the goal of improving patient care and outcomes.
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Affiliation(s)
- Thomas W Conlon
- Departments of Anesthesiology and Critical Care Medicine and
| | - Akira Nishisaki
- Departments of Anesthesiology and Critical Care Medicine and
| | - Yogen Singh
- Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Shazia Bhombal
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Hopital Antoine Béclère, University Hospitals of South Paris, AP-HP, Paris, France.,Physiopathology and Therapeutic Innovation Unit, Inserm U999, Université Paris-Saclay, Paris, France; and
| | - David O Kessler
- Department of Emergency Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Erik R Su
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Aaron E Chen
- Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - María V Fraga
- Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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21
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To See or Not to See… Is There Still a Question? Pediatr Crit Care Med 2019; 20:891-893. [PMID: 31483382 DOI: 10.1097/pcc.0000000000002041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Point-of-care ultrasound: Is it time to include it in the paediatric specialist training programme? An Pediatr (Barc) 2019. [DOI: 10.1016/j.anpede.2019.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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23
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Mayordomo-Colunga J, González-Cortés R, Bravo MC, Martínez-Mas R, Vázquez-Martínez JL, Renter-Valdovinos L, Conlon TW, Nishisaki A, Cabañas F, Bilbao-Sustacha JÁ, Oulego-Erroz I. [Point-of-care ultrasound: Is it time to include it in the paediatric specialist training program?]. An Pediatr (Barc) 2019; 91:206.e1-206.e13. [PMID: 31395389 DOI: 10.1016/j.anpedi.2019.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 11/16/2022] Open
Abstract
Point-of-care ultrasound (POCUS) has become an essential tool for clinical practice in recent years. It should be considered as an extension of the standard physical examination, which complements and enriches it without substituting it. POCUS enables the physician to answer specific clinical questions about the diagnosis, to understand better the pathophysiological context, to orientate the treatment, and to perform invasive procedures more safely. Despite its current use in many centres, and in most paediatric sub-specialties, there are currently no specific recommendations addressing educational aims in the different training areas, as well as methodology practice and the certification process in paediatrics. These ingredients are essential for POCUS implementation in daily practice, with a quality guarantee in terms of efficiency and safety. Several POCUS experts in different paediatric medicine environments performed a non-systematic review addressing the main paediatric POCUS applications in paediatrics. The lack of educational programs in POCUS in Spain is also discussed, and the experience in the United States of America in this topic is provided. Considering the current situation of POCUS in paediatrics, we strongly believe that it is urgent to establish evidence-based recommendations for POCUS training that should be the base to develop educational programs and to include POCUS in the paediatric residency training.
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Affiliation(s)
- Juan Mayordomo-Colunga
- Sección de Cuidados Intensivos Pediátricos, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, España; CIBER-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España; Grupo de Trabajo de Ecografía de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP), España; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España
| | - Rafael González-Cortés
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España; Red de Salud Materno Infantil y del Desarrollo. RETICS financiada por el ISCIII (Ref. 16/0022), Madrid, España; Grupo de Trabajo de Ecografía de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP), España
| | - María Carmen Bravo
- Departamento de Neonatología, Hospital Universitario La Paz, Madrid, España
| | - Roser Martínez-Mas
- Servicio de Urgencias de Pediatría, Hospital Universitario Cruces, Barakaldo, Vizcaya, España; Grupo de Trabajo de Ecografía a Pie de Cama de la Sociedad Española de Urgencias Pediátricas (SEUP), España
| | - José Luis Vázquez-Martínez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Ramón y Cajal, Madrid, España; Grupo de Trabajo de Ecografía de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP), España
| | - Luis Renter-Valdovinos
- Unidad de Cuidados Intensivos Pediátricos, Servicio de Medicina Pediátrica, Parc Taulí, Hospital Universitario, Sabadell, Barcelona, España; Unidad de Transporte Pediátrico, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España; Base SEM-Pediátrico BP61, Sistema de Emergencias Médicas de Catalunya (SEM), Barcelona, España; Grupo de Trabajo de Ecografía de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP), España
| | - Thomas W Conlon
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Filadelfia, Pensilvania, Estados Unidos
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Filadelfia, Pensilvania, Estados Unidos
| | - Fernando Cabañas
- Departamento de Pediatría y Neonatología, Hospital Universitario Quironsalud, Madrid, España; Fundación de Investigación Biomédica, Hospital Universitario La Paz, Madrid, España
| | - José Ángel Bilbao-Sustacha
- Área Básica de Salud de Riudoms, Riudoms, Tarragona, España; Grupo de Trabajo de Ecografía Clínica de la Asociación Española de Pediatría de Atención Primaria (AEPAP), España
| | - Ignacio Oulego-Erroz
- Cardiología Infantil, Unidad de Cuidados Intensivos Pediátricos, Servicio de Pediatría, Complejo Asistencial Universitario de León, León, España; IBIOMED, Instituto de Biomedicina de León, León, España; Grupo de Trabajo de Ecografía de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP), España.
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Reaume M, Siuba M, Wagner M, Woodwyk A, Melgar TA. Prevalence and Scope of Point-of-Care Ultrasound Education in Internal Medicine, Pediatric, and Medicine-Pediatric Residency Programs in the United States. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1433-1439. [PMID: 30255947 DOI: 10.1002/jum.14821] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/09/2018] [Indexed: 05/11/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the prevalence and scope of point-of-care ultrasound (US) education in internal medicine, pediatric, and medicine-pediatric residency programs nationwide. METHODS Program directors were surveyed between January and June 2016 with a 15-item online questionnaire to assess the state of point-of-care US training in their programs. The survey aimed to identify whether programs had an established point-of-care US curriculum and, if not, what reasons may have existed for a lack of point-of-care US training in their programs. RESULTS The survey was distributed to 685 program directors, and the response rate was 19.2%. Only 31.5% of respondents reported having a formal point-of-care US curriculum in their program, and in 12.4% of programs, there was no US training at all. The presence of point-of-care US training as reported by internal medicine (n = 64) and medicine-pediatric (n = 24) respondents showed formal point-of-care US curriculum rates of 37.5% and 43.5%, respectively. Pediatric programs (n = 24) reported limited point-of-care US training, with formal curriculum in only 12.4% of programs and 27.3% having no point-of-care US training at all. The most common reasons for lack of a point-of-care US curriculum among program directors were lack of trained faculty/instructors (70.4%), lack of guidelines/standards by governing societies (44.4%), and lack of the necessary technology (33.3%). CONCLUSIONS Less than half of residents with internal medicine training will have trained at a program with a point-of-care US curriculum, and point-of-care US training in pediatrics is even more limited. The major reason for the lack of point-of-care US education is a lack of trained faculty or instructors.
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Affiliation(s)
- Michael Reaume
- Department of Internal Medicine, Western Michigan University Homer Stryker, MD, School of Medicine, Kalamazoo, Michigan, USA
| | - Matthew Siuba
- Department of Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Michael Wagner
- Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Alyssa Woodwyk
- Biomedical Sciences, Western Michigan University Homer Stryker, MD, School of Medicine, Kalamazoo, Michigan, USA
| | - Thomas A Melgar
- Pediatrics and Adolescent and Internal Medicine, Western Michigan University Homer Stryker, MD, School of Medicine, Kalamazoo, Michigan, USA
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25
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Safarulla A, Kuhn W, Lyon M, Etheridge RJ, Stansfield B, Best G, Thompson A, Masoumy E, Bhatia J. Rapid Assessment of the Neonate With Sonography (RANS) Scan. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1599-1609. [PMID: 30244485 DOI: 10.1002/jum.14825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/17/2018] [Indexed: 06/08/2023]
Abstract
The use of point-of-care sonography in clinical settings such as emergency medicine and intensive care units has increased, but adoption in neonatology has been slow. Unlike the focused assessment with sonography for trauma scan used in adults, a quick bedside scan to rapidly evaluate an acutely deteriorating neonate does not exist. The objective of our article is to introduce a focused bedside ultrasound scan that is easy to learn, rapidly performed, and relatively inexpensive.© 2018 by the American Institute of Ultrasound in Medicine.
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Affiliation(s)
- Azif Safarulla
- Departments of Pediatrics, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Walter Kuhn
- Departments of Pediatrics, Augusta University Medical College of Georgia, Augusta, Georgia, USA
- Center for Ultrasound Education, Augusta University Medical College of Georgia, Augusta, Georgia, USA
- Emergency Medicine, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Matthew Lyon
- Center for Ultrasound Education, Augusta University Medical College of Georgia, Augusta, Georgia, USA
- Emergency Medicine, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Rebecca J Etheridge
- Center for Ultrasound Education, Augusta University Medical College of Georgia, Augusta, Georgia, USA
- Emergency Medicine, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Brian Stansfield
- Departments of Pediatrics, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Graciela Best
- Center for Ultrasound Education, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Amy Thompson
- Departments of Pediatrics, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Emily Masoumy
- Departments of Pediatrics, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Jatinder Bhatia
- Departments of Pediatrics, Augusta University Medical College of Georgia, Augusta, Georgia, USA
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Luong CL, Ong K, Kaila K, Pellikka PA, Gin K, Tsang TSM. Focused Cardiac Ultrasonography: Current Applications and Future Directions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:865-876. [PMID: 30146784 DOI: 10.1002/jum.14773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 06/08/2023]
Abstract
Focused cardiac ultrasonography is performed by clinicians at the bedside and is used in time-sensitive scenarios to evaluate a patient's cardiovascular status when comprehensive echocardiography is not immediately available. This simplified cardiac ultrasonography is often performed by noncardiologists using small, portable devices to augment the physical examination, triage patients, and direct management in both critical care and outpatient settings. However, as the use of focused cardiac ultrasonography continues to expand, careful consideration is required regarding training, scope of practice, impact on patient outcomes, and medicolegal implications. In this review, we examine some of the challenges with rapid uptake of this technique and explore the benefits and potential risk of focused cardiac ultrasonography. We propose possible mechanisms for cross-specialty collaboration, quality improvement, and oversight.
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Affiliation(s)
- Christina L Luong
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Ong
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kendeep Kaila
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patricia A Pellikka
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Kenneth Gin
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa S M Tsang
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Raggio BS, Harris WC, Winters RD, Graham HD. Analysis of Factors Associated With Malpractice Litigation in Rhinoplasty. ACTA ACUST UNITED AC 2019. [DOI: 10.1177/0748806819827408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rhinoplasty, the third most common cosmetic surgical procedure in the United States, represents the second most litigated facial plastic surgery procedure. Previous examinations of litigation specific to rhinoplasty are limited. The objective of this study was to comprehensively evaluate rhinoplasty malpractice litigation over the past 30 years and to investigate the financial burden of medical malpractice litigation associated with rhinoplasty, as well as factors that contribute to litigation and negative defendant outcomes. Jury verdict and payment reports related to rhinoplasty malpractice litigations over the past 30 years (1988-2018) were obtained using the WestlawNext and Nexis Uni subscription-based legal databases. The term “malpractice” was searched in combination with “rhinoplasty” and various names associated with the procedure. Cases included in the analysis were reviewed for outcomes, verdict payments, defendant specialty, and allegations raised in proceedings. Of the 46 cases identified, 12 (26%) were resolved with a plaintiff verdict payment. The median payment awarded was $127 500 (standard deviation, $96 590.63). The surgeon specialties found for 35 cases included otolaryngology (17 [49%]), plastic surgery (13 [37%]), facial plastic surgery (3 [9%]), and oral/maxillofacial surgery (OMFS; 2 [6%]). A greater proportion of cases involving otolaryngologists were resolved with payment compared with cases involving plastic surgeons (4 [24%] vs 1 [8%]), though this difference did not reach statistical significance ( P = .26). The most common allegations raised among the 46 cases were poor cosmesis (20 [43%]), intraoperative negligence (18 [39%]), inadequate informed consent (13 [28%]), and nasal function deficits (13 [28%]). Cases had a higher likelihood of being resolved in payment when allegations of cosmetic deformity (7%, 95% confidence interval [CI], −17.55 to 31.91) and nasal function deficit (17%, 95% CI, −9.29 to 45.32) were present, nevertheless these findings did not reach statistical significance ( P = .60 and P = .24, respectively). Rhinoplasty malpractice litigation resulting in payments can create substantial financial burden for the defendant. Common factors cited by plaintiffs for pursuing rhinoplasty malpractice litigation included cosmetic deformity, intraoperative negligence, lack of informed consent, and nasal function deficit. Cosmetic deformity and nasal function deficit allegations tended to result in negative defendant outcomes, though these findings are inconclusive. Our findings reinforce the importance of physician-patient communication, including conducting a comprehensive informed consent process, to limit or avoid postsurgical allegations.
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Affiliation(s)
| | | | - Ryan D. Winters
- Tulane University Medical Center, New Orleans, LA, USA
- Ochsner Clinic Foundation, New Orleans, LA, USA
| | - H. D. Graham
- Tulane University Medical Center, New Orleans, LA, USA
- Ochsner Clinic Foundation, New Orleans, LA, USA
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Hui DS, Miles KM, Lee R. Neurologic Injury Predicts Plaintiff Award in Federal Cardiac Surgery Trials. Ann Thorac Surg 2018; 106:691-695. [DOI: 10.1016/j.athoracsur.2018.03.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/08/2018] [Accepted: 03/22/2018] [Indexed: 02/03/2023]
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Niyyar VD, O'Neill WC. Point-of-care ultrasound in the practice of nephrology. Kidney Int 2018; 93:1052-1059. [PMID: 29477241 DOI: 10.1016/j.kint.2017.11.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/31/2017] [Accepted: 11/13/2017] [Indexed: 12/16/2022]
Abstract
Sonography is increasingly being performed by clinicians and has applications throughout the spectrum of nephrology, including acute and chronic renal failure, urinary obstruction, cystic disease, pain, hematuria, transplantation, kidney biopsy, temporary and permanent vascular access, and assessment of fluid status. The skill is relatively easily acquired, expedites patient care, and enhances the practice of nephrology. However, the lack of exposure in most training programs remains a major obstacle.
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Affiliation(s)
- Vandana Dua Niyyar
- Emory University, Department of Medicine, Renal Division, Atlanta, Georgia, USA
| | - W Charles O'Neill
- Emory University, Department of Medicine, Renal Division, Atlanta, Georgia, USA.
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Abstract
There is a growing interest worldwide in using echocardiography in the neonatal unit to act as a complement to the clinical assessment of the hemodynamic status of premature and term infants. However, there is a wide variation in how this tool is implemented across many jurisdictions, the level of expertise, including the oversight of this practice. Over the last 5 years, three major expert consensus statements have been published to provide guidance to neonatologists performing echocardiography, with all recommending a structured training program and clinical governance system for quality assurance. Neonatal practice in Europe is very heterogeneous and the proximity of neonatal units to pediatric cardiology centers varies significantly. Currently, there is no overarching governance structure for training and accreditation in Europe. In this paper, we provide a brief description of the current training recommendations across several jurisdictions including Europe, North America, and Australia and describe the steps required to achieve a sustainable governance structure with the responsibility to provide accreditation to neonatologist performed echocardiography in Europe.
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Nguyen J, Muniraman H, Cascione M, Ramanathan R. Communication-related allegations against physicians caring for premature infants. J Perinatol 2017; 37:1148-1152. [PMID: 28749484 DOI: 10.1038/jp.2017.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/10/2017] [Accepted: 05/30/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Maternal-fetal medicine physicians (MFMp) and neonatal-perinatal medicine physicians (NPMp) caring for premature infants and their families are exposed to significant risk for malpractice actions. Effective communication practices have been implicated to decrease litigious intentions but the extent of miscommunication as a cause of legal action is essentially unknown in this population. Analysis of communication-related allegations (CRAs) may help toward improving patient care and physician-patient relationships as well as decrease litigation risks. STUDY DESIGN We retrospectively reviewed the Westlaw database, a primary online legal research resource used by United States lawyers and legal professionals, for malpractice cases against physicians involving premature infants. Inclusion criteria were: 22 to 36 weeks gestational age, cases related to peripartum events through infant discharge and follow-up, and legal records with detailed factual narratives. RESULTS The search yielded 736 legal records, of which 167 met full inclusion criteria. A CRA was identified in 29% (49/167) of included cases. MFMp and/or NPMp were named in 104 and 54 cases, respectively. CRAs were identified in 26% (27/104) and 35% (19/54) of MFMp- and NPMp-named cases, respectively, with a majority involving physician-family for both specialties (81% and 74%, respectively). Physician-family CRAs for MFMp and NPMp most often regarded lack of informed consent (50% and 57%, respectively), lack of full disclosure (41% and 29%, respectively) and lack of anticipatory guidance (36% and 21%, respectively). CONCLUSIONS This study of a major legal database identifies CRAs as significant causes of legal action against MFMp and NPMp involved in the care of high-risk women and infants delivered preterm. Physicians should be especially vigilant with obtaining genuine informed consent and maintaining open communication with families.
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Affiliation(s)
- J Nguyen
- Division of Neonatal Medicine, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - H Muniraman
- Division of Neonatal Medicine, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - M Cascione
- UCLA School of Law, University of California Los Angeles, Los Angeles, CA, USA
| | - R Ramanathan
- Division of Neonatal Medicine, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Kandinov A, Mutchnick S, Nangia V, Svider PF, Zuliani GF, Shkoukani MA, Carron MA. Analysis of Factors Associated With Rhytidectomy Malpractice Litigation Cases. JAMA FACIAL PLAST SU 2017; 19:255-259. [PMID: 28199538 DOI: 10.1001/jamafacial.2016.1782] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance This study investigates the financial burden of medical malpractice litigation associated with rhytidectomies, as well as factors that contribute to litigation and poor defendant outcomes, which can help guide physician practices. Objective To comprehensively evaluate rhytidectomy malpractice litigation. Data Sources and Study Selection Jury verdict and settlement reports related to rhytidectomy malpractice litigations were obtained using the Westlaw Next database. Use of medical malpractice in conjunction with several terms for rhytidectomy, to account for the various procedure names associated with the procedure, yielded 155 court cases. Duplicate and nonrelevant cases were removed, and 89 cases were included in the analysis and reviewed for outcomes, defendant specialty, payments, and other allegations raised in proceedings. Data were collected from November 21, 2015, to December 25, 2015. Data analysis took place from December 25, 2015, to January 20, 2016. Results A total of 89 cases met our inclusion criteria. Most plaintiffs were female (81 of 88 with known sex [92%]), and patient age ranged from 40 to 76 years (median age, 56 years). Fifty-three (60%) were resolved in the defendant's favor, while the remaining 36 cases (40%) were resolved with either a settlement or a plaintiff verdict payment. The mean payment was $1.4 million. A greater proportion of cases involving plastic surgeon defendants were resolved with payment compared with cases involving defendants with ear, nose, and throat specialty (15 [36%] vs 4 [24%]). The most common allegations raised in litigation were intraoperative negligence (61 [69%]), poor cosmesis or disfigurement (57 [64%]), inadequate informed consent (30 [34%]), additional procedures required (14 [16%]), postoperative negligence (12 [14%]), and facial nerve injury (10 [11%]). Six cases (7%) involved alleged negligence surrounding a "lifestyle-lift" procedure, which tightens or oversews the superficial muscular aponeurosis system layer. Conclusions and Relevance In this study, although most cases of rhytidectomy malpractice litigation were resolved in the defendant's favor, cases resulting in payments created substantial financial burden for the defendants. Common factors cited by plaintiffs for pursuing litigation included dissatisfaction with cosmetic outcomes and perceived deficits in informed consent. These factors reinforce the importance of a comprehensive, preoperative informed consent process in which the specific potential risks and outcomes are presented by the surgeon to the patient to limit or avoid postsurgical allegations. Intraoperative negligence and facial nerve injury were significantly more likely to result in poor defendant outcomes. Level of Evidence NA.
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Affiliation(s)
- Aron Kandinov
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Sean Mutchnick
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Vaibhuv Nangia
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Peter F Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Giancarlo F Zuliani
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan2Division of Facial Plastic and Reconstructive Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Mahdi A Shkoukani
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan2Division of Facial Plastic and Reconstructive Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Michael A Carron
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan2Division of Facial Plastic and Reconstructive Surgery, Wayne State University School of Medicine, Detroit, Michigan
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Muniraman H, Cascione M, Ramanathan R, Nguyen J. Medicolegal cases involving periviable births from a major United States legal database. J Matern Fetal Neonatal Med 2017; 31:2043-2049. [DOI: 10.1080/14767058.2017.1335704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Hemananda Muniraman
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, LAC + USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Center for Fetal and Neonatal Medicine, Division of Neonatal-Perinatal Medicine, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Miranda Cascione
- UCLA School of Law, University California Los Angeles, Los Angeles, CA, USA
| | - Rangasamy Ramanathan
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, LAC + USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Center for Fetal and Neonatal Medicine, Division of Neonatal-Perinatal Medicine, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Jimmy Nguyen
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, LAC + USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Center for Fetal and Neonatal Medicine, Division of Neonatal-Perinatal Medicine, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
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Nguyen J, Amirnovin R, Ramanathan R, Noori S. The state of point-of-care ultrasonography use and training in neonatal-perinatal medicine and pediatric critical care medicine fellowship programs. J Perinatol 2016; 36:972-976. [PMID: 27513327 DOI: 10.1038/jp.2016.126] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/01/2016] [Accepted: 07/06/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The current state of point-of-care ultrasonography (POCUS) use and education in neonatal-perinatal medicine (NPM) and pediatric critical care medicine (PCCM) is unknown. Our aim was to quantify POCUS use, training and perceptions regarding education and barriers among the United States NPM and PCCM fellowship programs. STUDY DESIGN A 14-question survey was emailed to the fellowship directors of all the United States NPM and PCCM fellowship programs. RESULTS The response rate was 55% (52/95) and 59% (39/66) for NPM and PCCM programs, respectively. Over 90% of respondents in both groups believe that fellows and attendings should receive POCUS training. PCCM programs, compared with NPM, had greater access to POCUS machines (97% vs 63%, P<0.001), and more often used POCUS for diagnoses and management (76% vs 29%, P<0.001) and procedural guidance (95% vs 37%, P<0.001). The most common indications were cardiac/hemodynamics, pulmonary pathology and vascular access in both specialties. PCCM reported more training to fellows (90% vs 29%, P<0.001). Both group perceived lack of time to learn, lack of equipment/funds, liability concerns, lack of personnel to train physicians and cardiology/radiology resistance as significant barriers to POCUS implementation. CONCLUSIONS Both NPM and PCCM fellowship programs believe in the benefits of POCUS and that their physicians should receive the necessary training. Compared with PCCM, NPM fellowships programs have less access to POCUS machines and less frequently use POCUS and train their fellows and attendings. There remain significant barriers to utilization of POCUS, especially in NPM.
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Affiliation(s)
- J Nguyen
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Center for Fetal and Neonatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - R Amirnovin
- Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - R Ramanathan
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Center for Fetal and Neonatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - S Noori
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Center for Fetal and Neonatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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