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Blatt MI, Rupp J, Lipton M, Barrett TW, Boyd JS, Ward MJ. Effect of Departmental and Physician-Selected Interventions on Point-of-Care Ultrasound Documentation Completion. Cureus 2024; 16:e61675. [PMID: 38966489 PMCID: PMC11223751 DOI: 10.7759/cureus.61675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/06/2024] Open
Abstract
Background Point-of-care ultrasound (POCUS) has been disruptive to many experienced emergency physicians as it requires competence in a new physical skill, real-time image interpretation, and navigation of novel software for submission to the electronic health record (EHR). Incomplete documentation of a performed POCUS study used for clinical decision-making represents a potential medicolegal liability, may expose the patient to repetitive or potentially unnecessary imaging, and is a missed opportunity for reimbursement. Identifying effective facilitators of ED POCUS documentation completion requires additional investigation. Methods In the first part of this mixed-methods study, eligible attending physicians were stratified into levels of use ("high"/"low"/"never") based on recent POCUS documentation performance. Semi-structured interviews were conducted with high and low utilizers to explore their perceptions of the POCUS submission workflow and their receptivity to various proposed interventions. Qualitative data were analyzed using a thematic analysis that explored perceived usefulness and usability. The second part of the study consisted of two intervention phases. First, physicians achieving minimum POCUS documentation numbers were rewarded with additional shift scheduling flexibility. In the second phase, the intervention that garnered the most interview support, daily documentation reminder emails, was implemented. The primary outcome was the individual POCUS documentation rates calculated as all studies submitted divided by all studies performed (submitted plus unsubmitted) per month. Provider-level monthly data was aggregated into a departmental rate. Results Interviews were conducted with 12 physicians, six from the highest and six from the lowest documentation quartiles. Both groups supported the same two proposed interventions: reminder emails ranked first, then monetary rewards ranked second. High utilizers emphasized the clinical utility of POCUS, whereas low utilizers expressed concerns over "double billing" and exposure to medicolegal liability with uncertain scan interpretations. For low utilizers, a documentation decision could be dependent on the performing resident physician's displayed confidence. Both groups voiced frustration with the need to use a separate program, Qpath (Telexy Healthcare, Inc, Maple Ridge, British Columbia, Canada), for POCUS documentation. During intervention phase one, the aggregate departmental documentation rate increased from 44.6% to 60.1% with the introduction of the schedule request incentive. This improvement was seen across all documentation quartiles. The departmental rate remained stable and did not improve further following the addition of the daily documentation reminder emails in intervention phase two. When reminder emails ceased yet the day-off request incentive continued, the departmental rate did not drop. Conclusions The implementation of a non-financial shift scheduling incentive correlated with the largest increase in departmental POCUS documentation rate. Interviewees incorrectly predicted that email reminders would be the most influential intervention highlighting a mismatch between physician perception and effective drivers of behavior change. Further investigation may focus on determining the size and longevity of the isolated impact of a schedule request incentive, as one might expect diminishing marginal utility.
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Affiliation(s)
- Marc I Blatt
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Jordan Rupp
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Matthew Lipton
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Tyler W Barrett
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Jeremy S Boyd
- Department of Emergency Medicine, VA Tennessee Valley Healthcare System, Nashville, USA
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
- Geriatric Research, Education, and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, USA
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Brant JA, D'Amico B, Orsborn J, Toney AG, Lam SHF, Mickley M, Ambroggio L. Characterizing Point-of-Care Ultrasound Credentialing in Pediatric Emergency Departments. Pediatr Emerg Care 2024:00006565-990000000-00439. [PMID: 38713835 DOI: 10.1097/pec.0000000000003193] [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: 05/09/2024]
Abstract
OBJECTIVE It is unclear which pediatric emergency departments (PEDs) have a point-of-care ultrasound (POCUS) credentialing process or if this process is consistent per expert guidelines. Our objective was to describe formalized POCUS credentialing processes across PEDs that are active in the pediatric emergency medicine POCUS (P2) Network. METHODS A survey was developed from nationally recommended credentialing guidelines. This anonymous survey was sent out to the P2 Network comprising more than 230 members involved in pediatric POCUS. The survey was analyzed using descriptive analysis with counts and percentages. RESULTS A total of 36 PEDs responded to the survey. All departments had a faculty member in charge of maintaining the credentialing process, and all faculty members had POCUS education available; 88.6% of education was scheduled didactics or bedside teaching. There were 80.6% of PEDs that had a process for internally credentialing faculty. Some PEDs offered protected education for POCUS, however, 44.8% had <50% of their faculty credentialed. There were 4 PEDs that offered incentives for completion of POCUS credentialing including salary bonuses; only 1 offered shift buy down as incentive. That PED had 100% of its faculty credentialed. All PEDs performed quality assurance on POCUS scans done in the ED, most done weekly. Billing for scans occurred in 26 PEDs. Skin/soft tissue and focused assessment with sonography for trauma were the 2 most common applications credentialed. CONCLUSIONS Among PEDs surveyed, there was a lack of standardization of POCUS resources and components of credentialing. Incentives may be beneficial in improving credentialing faculty and standardizing the credentialing process.
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Affiliation(s)
- Julia Aogaichi Brant
- From the Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, Aurora, CO
| | - Beth D'Amico
- Division of Pediatric Emergency Medicine, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Jonathan Orsborn
- From the Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, Aurora, CO
| | - Amanda G Toney
- Department of Emergency Medicine, Denver Health, Denver, CO
| | - Samuel H F Lam
- From the Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, Aurora, CO
| | - Megan Mickley
- Division of Pediatric Emergency Medicine, ChristianaCare, Newark, DE
| | - Lilliam Ambroggio
- From the Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, Aurora, CO
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Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med 2023; 82:e115-e155. [PMID: 37596025 DOI: 10.1016/j.annemergmed.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 08/20/2023]
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Thompson B, Schoenfeld E, Westafer L, Visintainer P, Budhram G. Implementation of an automated, user-centered point-of-care ultrasound workflow improves documentation and billing. Acad Emerg Med 2023; 30:180-186. [PMID: 36617844 DOI: 10.1111/acem.14654] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/15/2022] [Accepted: 12/30/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is a central component of emergency medical care. However, clinicians often fail to adequately document their examinations, causing problems for downstream clinicians and quality assurance processes as well as loss of revenue. The objective of this study was to evaluate the impact of a user-centered POCUS documentation workflow system for examination ordering, documentation, selective archival, and billing on POCUS documentation in a large academic emergency department (ED). METHODS In this quasi-experimental study, we examined POCUS documentation 22 months before and 12 months after implementation of a user-centered, automated ultrasound workflow (October 2018-July 2021). The workflow allows for electronic health record (EHR) order entry to populate a virtual ultrasound worklist, automatic demographic information retrieval to ultrasound machines, selective image storage to a hospital picture archive and communications system and/or POCUS archive Ultralinq, generation of an EHR report, and integrated billing triggers. Data were retrieved using Current Procedural Terminology codes for billed POCUS examinations during the study period. We also collected monthly hospital registry data to quantify ED visits to control for volume. We compared the number and per-visit rate of POCUS documented using descriptive statistics and segmented linear regression before and after implementation of the workflow. RESULTS In the 22-month preimplementation period, 209,725 ED visits occurred. During this period, POCUS was completely documented in 13,514 or in 6.4% of ED visits. There were an average of 614 scans documented per month. In the 12-month postimplementation period, 97,418 ED visits occurred. During this period, POCUS was completely documented in 10,001 visits, or 10.3% of ED visits. There were an average of 833 scans documented per month. Linear regression analysis showed a significant increase in average monthly POCUS documentation of 265.34 scans/month (95% CI 150.60-380.09, p < 0.001) at the time of the intervention. CONCLUSIONS In this single-center study, POCUS documentation increased by more than 60% following the implementation of a user-centered POCUS workflow that reduced the burden on the clinician by automating data entry, improving data flow between ultrasound machines and the EHR and integrating billing.
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Affiliation(s)
- Brian Thompson
- Department of Emergency Medicine, UMass Chan - Baystate, Springfield, Massachusetts, USA
| | - Elizabeth Schoenfeld
- Department of Emergency Medicine, UMass Chan - Baystate, Springfield, Massachusetts, USA.,Department of Healthcare Delivery and Population Sciences, Springfield, Massachusetts, USA
| | - Lauren Westafer
- Department of Emergency Medicine, UMass Chan - Baystate, Springfield, Massachusetts, USA.,Department of Healthcare Delivery and Population Sciences, Springfield, Massachusetts, USA
| | - Paul Visintainer
- Epidemiology and Biostatistics Research Core, UMass Chan - Baystate, Springfield, Massachusetts, USA
| | - Gavin Budhram
- Department of Emergency Medicine, UMass Chan - Baystate, Springfield, Massachusetts, USA
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Elsayed T, Snelling PJ, Stirling EJ, Watkins S. Emergency medicine trainees' perceived barriers to training and credentialing in point-of-care ultrasound: A cross-sectional study. Australas J Ultrasound Med 2022; 25:160-165. [PMID: 36405796 PMCID: PMC9644443 DOI: 10.1002/ajum.12317] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Point-of-care ultrasound (POCUS) is an important tool in emergency medicine (EM), with the Australasian College for Emergency Medicine (ACEM) recommending core modalities as part of fellowship training. In Australia, acquisition of these skills is certified via credentialing but is currently poorly undertaken by EM trainees. Methods We performed a cross-sectional survey of EM trainees across two academic teaching hospitals in Gold Coast, Queensland, between December 2018 and January 2019, to determine the current state of training and perceived barriers to credentialing in POCUS. Results Fifty-two (59%) eligible EM trainees participated. Although credentialing rates (15%) were low amongst respondents, the majority agreed that it was necessary (69%) and should form part of ACEM training (88%). Amongst these trainees, we identified the desire for increased POCUS training and several barriers including time constraints and the credentialing process itself. Conclusion Although there is general agreement amongst EM trainees for POCUS credentialing, barriers such as time limitations and technical difficulties were prohibitive for many. We propose the development of an internal structured POCUS training programme within mandatory training time to address these issues.
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Affiliation(s)
- Tarek Elsayed
- Emergency DepartmentGold Coast Hospital and Health ServiceSouthport4215QueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
- Faculty of Health Sciences & MedicineBond UniversityRobinaQueenslandAustralia
| | - Peter J. Snelling
- Emergency DepartmentGold Coast Hospital and Health ServiceSouthport4215QueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
- Faculty of Health Sciences & MedicineBond UniversityRobinaQueenslandAustralia
- Child Health Research CentreUniversity of QueenslandQueenslandAustralia
- Sonography Innovation and Research (Sonar) GroupGold CoastQueenslandAustralia
| | - Erin J. Stirling
- Emergency DepartmentGold Coast Hospital and Health ServiceSouthport4215QueenslandAustralia
| | - Stuart Watkins
- Emergency DepartmentGold Coast Hospital and Health ServiceSouthport4215QueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
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Zisblatt L, Byrne M, Chen F, Caldwell M. Graduate Medical Education Can Be an Impetus for Behavior Changes in Physicians in Practice: Point-Of-Care Ultrasound Faculty Development Intervention in Anesthesiology. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:90-96. [PMID: 35180744 DOI: 10.1097/ceh.0000000000000422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION While there is growing evidence to suggest that point-of-care ultrasound (POCUS) may aid in clinical decision-making in the perioperative setting and there are new requirements that anesthesiology residents must be trained in POCUS, few practicing anesthesiologists use POCUS in their practice. The goal of this investigation is to determine whether a multifaceted faculty development program helps a group of faculty members incorporate POCUS into their practice. METHODS This intervention had five parts: (1) online prework, (2) 2-day workshop, (3) follow-up hands-on sessions, (4) regular communication, and (5) equipment acquisition. This is a pretest/posttest, single group, observational study where the main outcome measure is the number of POCUS examinations documented and the number of providers who performed at least one examination. In addition, presurveys and postsurveys were administered to determine whether there was a change in confidence and self-reported use of POCUS. RESULTS The number of examinations completed and the number of providers completing examinations by month both seemed to increase over time between May 2017 and October 2018. Between August 2017 and October 2018, the number of examinations completed per month increased by a rate of approximately one examination per month (starting with one examination in May 2017) and the number of providers completing examinations increased by a rate of approximately 0.61 providers per month (staring with one provider in May 2017). DISCUSSION This study shows that an intervention that targets interested faculty can increase the use of POCUS in practice and residents' perceptions of teaching.
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Affiliation(s)
- Lara Zisblatt
- Dr. Zisblatt: Education Specialist, Department of Anesthesiology at University of Michigan Health System, Ann Arbor, MI. Dr. Byrne: Assistant Professor, Department of Anesthesiology at University of Michigan Health System, Ann Arbor, MI. Dr. Chen: Assistant Professor, Medical Education, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Caldwell: Assistant Professor, Department of Anesthesiology at University of Michigan Health System, Ann Arbor, MI
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Kennedy SK, Ferre RM, Rood LK, Nti B, Ehrman RR, Brenner D, Rutz MA, Zahn GS, Herbert AG, Russell FM. Success of implementation of a systemwide point-of-care ultrasound privileging program for emergency medicine faculty. AEM EDUCATION AND TRAINING 2022; 6:e10744. [PMID: 35493291 PMCID: PMC9045579 DOI: 10.1002/aet2.10744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/10/2022] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Point-of-care ultrasound (POCUS) is widely used in the emergency department (ED). Not all practicing emergency physicians received POCUS training during residency, leaving a training gap that is reflected in POCUS privileging. The purpose of this study was to evaluate the success of meeting privileging criteria as well as associated factors, following implementation of a basic POCUS training and privileging program within a large emergency medicine department. METHODS We implemented a POCUS training and privileging program, based on national guidelines, for faculty physicians who worked at one of the following EDs staffed by the same emergency medicine department: a pediatric tertiary site, two tertiary academic sites, and seven community sites. POCUS examinations included aorta, cardiac, first-trimester obstetrics (OB), and extended focused assessment with sonography in trauma. Pediatric emergency medicine faculty were taught soft tissue and thoracic US instead of aorta and OB. Completion of the program required 16 h of didactics, ≥25 quality-assured US examinations by examination type, and passing a series of knowledge-based examinations. Descriptive statistics were calculated. Associations between physician characteristics and successfully becoming privileged in POCUS were modeled using Firth's logistic regression. RESULTS A total of 176 faculty physicians were eligible. A total of 145 (82.4%) achieved basic POCUS privileging during the study period. Different pathways were used including 86 (48.9%) practice-based, nine (5.1%) fellowship-based, and 82 (46.9%) residency-based. POCUS privileging was lower for those working in a community versus academic setting (odds ratio 0.3, 95% confidence interval 0.1-0.9). A greater number of scans completed prior to the privileging program was associated with greater success. CONCLUSIONS Implementation of a POCUS training and privileging program can be successful in a large emergency medicine department that staffs hospitals in a large-scale health care system composed of both academic and community sites. Faculty physicians with at least some prior exposure to POCUS were more successful.
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Affiliation(s)
- Sarah K. Kennedy
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Robinson M. Ferre
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Loren K. Rood
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Benjamin Nti
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Robert R. Ehrman
- Department of Emergency MedicineWayne State University School of MedicineDetroit Medical Center/Sinai‐Grace HospitalDetroitMichiganUSA
| | - Daniel Brenner
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Matt A. Rutz
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Greg S. Zahn
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Audrey G. Herbert
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Frances M. Russell
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
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Russell FM, Kennedy SK, Rood LK, Nti B, Herbert A, Rutz MA, Palmer M, Ferre RM. Design and implementation of a basic and global point of care ultrasound (POCUS) certification curriculum for emergency medicine faculty. Ultrasound J 2022; 14:10. [PMID: 35182232 PMCID: PMC8858359 DOI: 10.1186/s13089-022-00260-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
Point of care ultrasound (POCUS) use in the emergency department is associated with improved patient outcomes and increased patient satisfaction. When used for procedural guidance, it has been shown to increase first pass success and decrease complications. As of 2012, ultrasound has been identified as a core skill required for graduating emergency medicine (EM) residents. Despite this, only a minority of EM faculty who trained prior to 2008 are credentialed in POCUS. Half of all EM training programs in the United States have less than 50% of their faculty credentialed to perform and teach POCUS to learners. As the use of POCUS continues to grow in medicine, it is especially important to have a pathway for faculty to attain competence and become credentialed in POCUS. The goal of this paper was to outline an implementation process of a curriculum designed to credential EM faculty in POCUS.
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Affiliation(s)
- Frances M Russell
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA.
| | - Sarah K Kennedy
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA
| | - Loren K Rood
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA
| | - Benjamin Nti
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA
| | - Audrey Herbert
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA
| | - Matt A Rutz
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA
| | - Megan Palmer
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA
| | - Robinson M Ferre
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA
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Nti BK, Kennedy S, Sarmiento E, Weinstein E, Russell F. Performance of Pediatric Emergency Medicine Faculty After Point-of-Care Ultrasound Credentialing Implementation. Pediatr Emerg Care 2022; 38:e482-e487. [PMID: 35025189 DOI: 10.1097/pec.0000000000002381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE As point-of-care ultrasound (POCUS) continues to evolve, a national standardized curriculum for training and credentialing pediatric emergency medicine (PEM) physicians is still lacking. The goal of this study was to assess PEM faculty in performing and interpreting POCUS during implementation of a training curriculum. METHODS Sixteen full-time PEM faculty with either limited or no prior POCUS experience were trained to perform 4 ultrasound studies. Twelve of the 16 completed the training with a goal of credentialing within 12 months of implementation. For each faculty, we assessed competency by comparing precurriculum and postcurriculum test assessments and by evaluating quality of POCUS acquisition and accuracy of interpretation. We also monitored the amount of continuing medical education (CME) hours completed to ensure a minimum didactic component. RESULTS We found a significant improvement in POCUS competency comparing precurriculum to postcurriculum test assessments (55.4% vs 75.6%, P < 0.0002). One thousand two hundred seventy images were submitted over the course of the curriculum. Accuracy, sensitivity, and specificity were 98.23% (confidence interval [CI] = 97.18-98.97), 97.01% (CI = 92.53-99.81), and 98.43% (CI = 97.33-99.81), respectively. Faculty self-rating of image quality was significantly higher than expert reviewer rating of image quality (3.4 ± 0.86 vs 3.2 ± 0.56, P < 0.0001). We found no change in expert reviewer rating of image quality over time. Faculty completed a combined 232.5 CME hours (average, 17.4 ± 10.8), with the majority of hours coming from an institutional POCUS CME workshop. CONCLUSIONS These results show that a structured curriculum can improve PEM faculty POCUS competency.
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Affiliation(s)
| | - Sarah Kennedy
- Clinical Ultrasound, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Elisa Sarmiento
- Clinical Ultrasound, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | | | - Frances Russell
- Clinical Ultrasound, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
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Rajamani A, Galarza L, Sanfilippo F, Wong A, Goffi A, Tuinman P, Mayo P, Arntfield R, Fisher R, Chew M, Slama M, Mackenzie D, Ho E, Smith L, Renner M, Tavares M, Prabu R N, Ramanathan K, Knudsen S, Bhat V, Arvind H, Huang S. Criteria, Processes, and Determination of Competence in Basic Critical Care Echocardiography Training: A Delphi Process Consensus Statement by the Learning Ultrasound in Critical Care (LUCC) Initiative. Chest 2022; 161:492-503. [PMID: 34508739 DOI: 10.1016/j.chest.2021.08.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND With the paucity of high-quality studies on longitudinal basic critical care echocardiography (BCCE) training, expert opinion guidelines have guided BCCE competence educational standards and processes. However, existing guidelines lack precise detail due to methodological flaws during guideline development. RESEARCH QUESTIONS To formulate methodologically robust guidelines on BCCE training using evidence and expert opinion, detailing specific criteria for every step, we conducted a modified Delphi process using the principles of the validated AGREE-II tool. Based on systematic reviews, the following domains were chosen: components of a longitudinal BCCE curriculum; pass-grade criteria for image-acquisition and image-interpretation; and formative/summative assessment and final competence processes. STUDY DESIGN AND METHODS Between April 2020 and May 2021, a total of 21 BCCE experts participated in four rounds. Rounds 1 and 2 used five web-based questionnaires, including branching-logic software for directed questions to individual panelists. In round 3 (videoconference), the panel finalized the recommendations by vote. During the journal peer-review process, Round 4 was conducted as Web-based questionnaires. Following each round, the agreement threshold for each item was determined as ≥ 80% for item inclusion and ≤ 30% for item exclusion. RESULTS Following rounds 1 and 2, agreement was reached on 62 of 114 items. To the 49 unresolved items, 12 additional items were added in round 3, with 56 reaching agreement and five items remaining unresolved. There was agreement that longitudinal BCCE training must include introductory training, mentored formative training, summative assessment for competence, and final cognitive assessment. Items requiring multiple rounds included two-dimensional views, Doppler, cardiac output, M-mode measurement, minimum scan numbers, and pass-grade criteria. Regarding objective criteria for image-acquisition and image-interpretation quality, the panel agreed on maintaining the same criteria for formative and summative assessment, to categorize BCCE findings as major vs minor and a standardized approach to errors, criteria for readiness for summative assessment, and supervisory options. INTERPRETATION In conclusion, this expert consensus statement presents comprehensive evidence-based recommendations on longitudinal BCCE training. However, these recommendations require prospective validation.
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Affiliation(s)
- Arvind Rajamani
- University of Sydney Nepean Clinical School, Intensive Care Medicine, Kingswood, NSW, Australia; Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia.
| | - Laura Galarza
- Department of Intensive Care, Hospital General Universitario de Castellon, Castellon de la Plana, Spain
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco," Catania, Italy
| | - Adrian Wong
- Department of Critical Care, King's College Hospital, London, UK
| | - Alberto Goffi
- Department of Critical Care Medicine and Li Ka Shing Knowledge Institute, St. Michael's Hospital Toronto, Toronto, ON, Canada; Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Pieter Tuinman
- Department of Intensive Care Medicine, Amsterdam University Medical Centers VUmc, Amsterdam, The Netherlands; Amsterdam Leiden Intensive Care Focused Echography (ALIFE), Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Paul Mayo
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY; Department of Pulmonary and Critical Care Medicine, Long Island Jewish Medical Center, New Hyde Park, NY
| | - Robert Arntfield
- Division of Critical Care, Department of Medicine, Western University, London, ON, Canada
| | - Richard Fisher
- Department of Critical Care, King's College Hospital, London, UK
| | - Michelle Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Michel Slama
- Medical Intensive Care, DRIME Department, University Hospital of Amiens, Amiens, France
| | - David Mackenzie
- Department of Emergency Medicine, Maine Medical Center, Portland, ME
| | - Eunise Ho
- Department of Intensive Care, Princess Margaret Hospital, Hong Kong, China
| | - Louise Smith
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia
| | - Markus Renner
- Department of Intensive Care Medicine, Dunedin Hospital, Dunedin, New Zealand; Otago University, New Zealand
| | - Miguel Tavares
- Department of Anesthesiology and Critical Care, Hospital Geral de Santo António, Porto, Portugal
| | - Natesh Prabu R
- Department of Critical Care Medicine, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Kollengode Ramanathan
- Cardiothoracic Intensive Care Unit, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Vijeth Bhat
- John Hunter Hospital, Intensive Care Unit, New Lambton Heights, NSW, Australia
| | | | - Stephen Huang
- University of Sydney Nepean Clinical School, Intensive Care Medicine, Kingswood, NSW, Australia
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Melton M, Rupp JD, Blatt MI, Boyd JS, Barrett TW, Swarm M, Ward MJ. Description of the Use of Incentives and Penalties for Point-of-Care Ultrasound Documentation Compliance in an Academic Emergency Department. Cureus 2021; 13:e16199. [PMID: 34367802 PMCID: PMC8341210 DOI: 10.7759/cureus.16199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives Incomplete documentation and submission to the electronic health record of performed point-of-care ultrasound (POCUS) studies is problematic from a patient care, medicolegal, and billing standpoint. Positive and negative financial incentives may be used to motivate physicians to complete documentation workflow. The most efficacious route to improve POCUS workflow completion remains to be determined. Materials and methods A retrospective analysis of POCUS documentation in an academic emergency department during four distinct six-month blocks was performed. POCUS workflow completion was assessed without incentives (Baseline), with financial bonus (Incentive), interim period (Washout), and with a negative financial incentive (Penalty) to determine the effect of these incentives on workflow completion. Results There was an appreciable increase in the rate of POCUS studies documented between the "Baseline" (no incentive) and "Incentive" (small financial bonus) time periods. The improvement remained stable during the "Washout" (interim) period, and then increased further in the "Penalty" (negative financial incentive) period. This improvement was relatively diffuse among the providers studied. A similar pattern - improvements in the Incentive and Penalty periods with stability in the Washout - was also observed in the POCUS volume data (number of studies performed). Conclusions This study reveals a positive association between the implementation of both financial incentives and financial penalties, which increases in POCUS documentation among attending physicians at an academic emergency department.
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Affiliation(s)
- Myles Melton
- Emergency Medicine, Olympia Emergency Services, Olympia, USA
| | - Jordan D Rupp
- Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Marc I Blatt
- School of Medicine, Vanderbilt University, Nashville, USA
| | - Jeremy S Boyd
- Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Tyler W Barrett
- Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Matthew Swarm
- Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Michael J Ward
- Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
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Toffoli A, Hartnett L, Mattick A, Goudie A. Credentialing of emergency medicine trainees in point-of-care ultrasound: An effective, efficient and enjoyable model. Emerg Med Australas 2021; 33:473-479. [PMID: 33084242 DOI: 10.1111/1742-6723.13657] [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: 07/07/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Australasian College for Emergency Medicine Curriculum Framework contains numerous mentions of point-of-care ultrasound (PoCUS). However, obtaining formal PoCUS credentials is often problematic. The Fiona Stanley Hospital ED PoCUS training programme was devised to assist emergency medicine trainees to meet the credentialing requirements of the Australasian College for Emergency Medicine and the Australasian Society for Ultrasound in Medicine. METHODS Six emergency medicine registrars are selected for each 6-month semester. Successful applicants nominate two modules of Australasian Society for Ultrasound in Medicine's Certificate in Clinician Performed Ultrasound and receive dedicated non-clinical time. For 3 h a week, an emergency physician holding formal PoCUS credentials supervises a pair of trainees while they perform scans on ED patients. During these sessions, trainee logbooks can be reviewed and assessments occur as required by the module. RESULTS Over an 18-month period, 18 emergency registrars were involved, averaging eight 3-h sessions each. All selected the Extended Focused Abdominal Scan for Trauma module, 14 chose Abdominal Aortic Aneurysm and eight chose Basic Echo in Life Support. Overall, 30 (75%) of 40 modules were completed within the trainees' 6-month semester. Just under half of logged scans were obtained during the supervised sessions. Overall, the average number of scans performed exceeded each module's logbook requirements. Trainees perceived that involvement in the programme benefited their ability to manage patients. There was overwhelming support for the structure of the programme. CONCLUSIONS The Fiona Stanley Hospital ED model is effective in assisting emergency medicine trainees to gain formal PoCUS credentials. As it requires relatively little organisation, time and staffing, it could be adopted in many EDs around Australia and New Zealand.
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Affiliation(s)
- Andrew Toffoli
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Leanne Hartnett
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Anthony Mattick
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Adrian Goudie
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Mackenzie DC. "I Know It When I See It". Chest 2021; 158:844-845. [PMID: 32892877 DOI: 10.1016/j.chest.2020.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 04/29/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- David C Mackenzie
- Department of Emergency Medicine, Maine Medical Center, Portland, ME.
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Long J, Meyering S, Scheel T. Approach to Formalized Ultrasound Credentialing in a Community Hospital Health System with both Academic and Non-Academic Clinical Settings. Spartan Med Res J 2020; 5:12748. [PMID: 33655179 PMCID: PMC7746098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/15/2020] [Indexed: 10/08/2023] Open
Abstract
INTRODUCTION In the US, ultrasound in Emergency Medicine (EM) is widely considered the standard of care in clinical practice amongst most Emergency Department providers. At the authors' institution and affiliates, there were a variety of health care providers utilizing ultrasound for clinical practice, and their skill levels varied, dependent on training and exposure. As an attempt to standardize credentialing practice and determine need for additional training thresholds, the authors endeavored to perform a skills assessment utilizing both written and clinical based practical assessments. METHODS A 7 point questionnaire was administered to a convenience sample of providers requesting formal training information, number of ultrasounds performed, and self-assessed competency. A 10 point written assessment with ultrasound knowledge and clinical application questions was also administered. A subsequent clinical assessment on live humans and models was then performed with multiple stations assessing 15 different instrumentation skills and technique, as well as image interpretation and evaluation. RESULTS A total of 23 attending EM board-certified physicians, and four advanced practice providers (PA and NP) took the credentialing assessments scoring an average of 7.3 out of 10 (SD 0.83) for the written assessment. Twenty (71%) of the 28 tested passed the clinical evaluation on their initial attempt. Five (17%) passed on a first remediation. Three (10%) required more than one initial revision attempt. All those who did remediate were able to complete the revision with a passing score. CONCLUSIONS Overall, the testing was considered a successful process. This program appears to have offered a level of standardization that was appealing to the credentialing body at our institution. We were able to assess to a level of competence considered standard of care by national credentialing bodies.
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Shiber J, Fontane E, Newberry M. Transesophageal Echocardiography Use During Cardiopulmonary Resuscitation. Ann Emerg Med 2020; 74:823. [PMID: 31779960 DOI: 10.1016/j.annemergmed.2019.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Indexed: 11/19/2022]
Affiliation(s)
| | | | - Mark Newberry
- Department of Emergency Medicine, Mt Sinai Medical Center, Miami, FL
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Standardizing Point-of-Care Ultrasound Credentialing Across a Large Health Care System. Jt Comm J Qual Patient Saf 2020; 46:471-476. [PMID: 32430248 DOI: 10.1016/j.jcjq.2020.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is becoming prevalent in the daily practice of bedside clinicians. As large health care systems standardize practice patterns, an organized approach of credentialing physicians in POCUS is paramount for quality and patient safety. This study describes a systematic approach of credentialing a diverse group of community emergency physicians (EPs) across a large health care system. METHODS A multimodal POCUS credentialing initiative for EPs was implemented across 11 hospitals between January 1, 2017, and July 1, 2018, that included (1) standardization of POCUS credentialing for all hospitals in the system, (2) tiered POCUS credentialing (Basic and Intermediate) for manageable attainment of goals with a required POCUS course, (3) automatic privileges for EPs who completed residency or practice-based POCUS pathways prior to employment, and (4) implementation of a practice-based pathway for competency assessment for noncredentialed physicians. Key factors for implementation included executive administrative support, dedicated POCUS courses, equipment standardization, a robust electronic medical record capable of logging training scans, and competency assessment for attainment of privileges. RESULTS Through the initiative, 78/106 EPs achieved Intermediate credentialing, and 28/106 were without POCUS privileges. All 28 noncredentialed EPs completed the required Basic POCUS course. Almost half (13/28) completed the initiative and became credentialed. From 2016 to 2018, the number of EPs performing scans increased from 52 to 112, and the number of POCUS scans increased from 928 to 3,007. CONCLUSION A standardized POCUS credentialing initiative can be successfully implemented in large health care systems. Other specialties can use this initiative to implement POCUS into their daily practice.
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Schnittke N, Damewood S. Identifying and Overcoming Barriers to Resident Use of Point-of-Care Ultrasound. West J Emerg Med 2019; 20:918-925. [PMID: 31738719 PMCID: PMC6860390 DOI: 10.5811/westjem.2019.8.43967] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/05/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction Emergency medicine residency programs have rigorous point-of-care ultrasound (POCUS) curricula. However, this training does not always readily translate to routine use in clinical decision-making. This study sought to identify and overcome barriers that could prevent resident physicians from performing POCUS during clinical shifts. Methods This was a two-step process improvement study. First, a survey was deployed to all residents of a three-year academic residency program to identify barriers to clinical use of POCUS. This survey identified the perceived lack of a uniform documenting protocol as the most important barrier to performing POCUS on shift. Second, as an intervention to overcome this barrier, a streamlined documentation protocol was developed and presented to residents. The primary outcome was the number of patients who had POCUS used in medical decision-making one year before and after intervention. Secondary outcomes were the level of training of residents performing exams and whether faculty overseeing exams were trained through an ultrasound fellowship program. Results POCUS use by residents increased from 82 to 223 patients before and after the intervention, respectively. Per resident, this translates to an absolute increase from 2.2 (95% confidence intervall [CI], 1.4, 3) to 5.8 (95% CI, 4, 7.6) or 3.6 (95% CI, 1.8, 5.4) exams/resident over the study period. We observed no significant difference in the proportions of scans attributable to the resident level of training (χ2 = 0.5, p = 0.47). The proportion of exams by non-ultrasound fellowship trained faculty increased significantly more compared to fellowship trained faculty (χ2 = 19, p<0.0001); however, both ultrasound fellowship trained and non-ultrasound fellowship trained faculty increased the absolute number of exams performed. Conclusion A key perceived barrier to resident-performed POCUS is unfamiliarity with documenting ultrasounds for medical decision-making. Educating residents in person about a POCUS documentation protocol may help overcome this barrier. Incorporating resident input and motivation into POCUS incentivization may increase utilization. Future studies in optimizing POCUS on shift will need to focus on streamlining documentation, addressing time constraints, and faculty support for resident-performed POCUS.
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Affiliation(s)
- Nikolai Schnittke
- Oregon Health and Science University, Department of Emergency Medicine, Portland, Oregon
| | - Sara Damewood
- University of Wisconsin School of Medicine and Public Health, Department of Emergency Medicine, Madison, Wisconsin
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Matyal R, Mitchell JD, Mahmood F, Oren-Grinberg A, Leibowitz A, Amador Y, Wong V, Khamooshian A, Mahmood F, Amir R, Bortman J, Jones SB. Faculty-Focused Perioperative Ultrasound Training Program: A Single-Center Experience. J Cardiothorac Vasc Anesth 2019; 33:1037-1043. [DOI: 10.1053/j.jvca.2018.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Indexed: 11/11/2022]
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Abstract
OBJECTIVE We sought to determine which interventions have effectively increased point-of-care ultrasound (US) use in a pediatric emergency department (ED). DESIGN/METHODS We evaluated the impact of specific interventions conducted over a 5-year period (2010-2015) on point-of-care US performance in a tertiary care pediatric ED. Ultrasound use by attending physicians and fellows was ascertained from a departmental database. Interventions assessed included the following: (1) initiation of an US fellowship, (2) acquisition of a second US machine, (3) performance of an US-related research project in the department, (4) initiation of faculty US curriculum, (5) earlier introduction of US education for pediatric emergency medicine fellows, and (6) administrative mandate dictating faculty requirements for credentialing. Mean monthly US use was trended over time using statistical process control methodology, and the impact of major interventions was analyzed using interrupted time-series analyses. RESULTS The mean number of US scans increased from 2.0 to 5.9 per attending per month and from 4.3 to 7.1 per fellow per month over the study period. Using interrupted time-series analyses, we observed the only intervention to significantly increase attending US utilization was an administrative credentialing mandate, with an associated increase of 6% per month (incidence rate ratio, 1.06; 95% confidence interval, 1.01-1.11). CONCLUSIONS Point-of-care US use has increased over time for both fellows and attending physicians. We observed that an administrative mandate led to a significant increase in US use among attending physicians.
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Ketelaars R, Van Heumen E, Baken LP, Witten M, Scheffer GJ, Engels Y, Hoogerwerf N. Emergency physicians’ attitudes to implementing ultrasound in Dutch emergency departments after a 2-day training: A qualitative study. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918771812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Diagnostic ultrasound is increasingly used by nonradiologists in trauma victims and critically ill patients. In the emergency department, the extended focused assessment with sonography for trauma and Polytrauma Rapid Echo-evaluation Program protocol are often used to assess these patients. Dutch Polytrauma Rapid Echo-evaluation Program-trained Emergency physicians are implementing the use of ultrasound in the emergency department but might encounter barriers to overcome. Objectives: This study aims to explore individual experiences of Dutch emergency physicians. Methods: We performed a qualitative study by conducting semi-structured interviews in Dutch emergency physicians working in a Level 2 emergency department that completed the 2-day Polytrauma Rapid Echo-evaluation Program course at least 1 year before the interviews. Data were analyzed using directed content analysis. Results: Eight emergency physicians employed by eight different hospitals were interviewed. Thirteen categories were identified in the transcribed interviews and these were combined into four general themes: (1) the desire to develop the Emergency Medicine specialty, both nationally and local; (2) incentives to start using ultrasound; (3) exploring practical applications of ultrasound; and (4) barriers faced while implementing emergency physician-performed ultrasound on the emergency department. The interviewees regard the course to be a solid base and are eager to independently perform ultrasound examinations, although challenges are faced. Conclusion: This exploratory study provides essential insight in Dutch emergency physicians implementing ultrasound in their emergency department. It shows that there is a need to develop a quality assurance system and it identified barriers that have to be dealt with.
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Affiliation(s)
- Rein Ketelaars
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
- Helicopter Emergency Medical Service, Lifeliner 3, Radboud university medical center, Nijmegen, The Netherlands
| | - Esther Van Heumen
- Department of Radiology, Haga Hospital, The Hague, The Netherlands
- Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Lambert P Baken
- Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Marja Witten
- Emergency Department, Flevoziekenhuis, Almere, The Netherlands
| | - Gert Jan Scheffer
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Nico Hoogerwerf
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
- Helicopter Emergency Medical Service, Lifeliner 3, Radboud university medical center, Nijmegen, The Netherlands
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Lamprecht H, Lemke G, van Hoving D, Kruger T, Wallis L. Poor return on investment: investigating the barriers that cause low credentialing yields in a resource-limited clinical ultrasound training programme. Int J Emerg Med 2018; 11:11. [PMID: 29468453 PMCID: PMC5821624 DOI: 10.1186/s12245-018-0168-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 02/07/2018] [Indexed: 11/17/2022] Open
Abstract
Background Clinical ultrasound is commonly used in medical practices worldwide due to the multiple benefits the modality offers clinicians. Rigorous credentialing standards are necessary to safeguard patients against operator errors. The purpose of the study was to establish and analyse the barriers that specifically lead to poor credentialing success within a resource-limited clinical ultrasound training programme. Methods An electronic cross-sectional survey was e-mailed to all trainees who attended the introductory clinical ultrasound courses held in Cape Town since its inception in 2009 to 2013. All trainees were followed until they completed their training programme in 2015. Results Only one fifth of trainees (n = 43, 19.7%), who entered the Cape Town training programme, credentialed successfully. Ninety (n = 90, 41.3%) trainees responded to the survey. Eighty-six (n = 86) surveys were included for analysis. Time constraints were the highest ranked barrier amongst all trainees. Access barriers (to trainers and ultrasound machines) were the second highest ranked amongst the non-credentialed group. A combination between access and logistical barriers (e.g. difficulty in finding patients with pathology to scan) were the second highest ranked in the credentialed group. Conclusions Access barriers conspire to burden the Cape Town clinical ultrasound training programme. Novel solutions are necessary to overcome these access barriers to improve future credentialing success. Electronic supplementary material The online version of this article (10.1186/s12245-018-0168-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hein Lamprecht
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa.
| | - Gustav Lemke
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - Daniel van Hoving
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - Thinus Kruger
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lee Wallis
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
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Das D, Kapoor M, Brown C, Ndubuisi A, Gupta S. Current status of emergency department attending physician ultrasound credentialing and quality assurance in the United States. Crit Ultrasound J 2016; 8:6. [PMID: 27230231 PMCID: PMC4880803 DOI: 10.1186/s13089-016-0042-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/11/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The use of emergency ultrasonography (EUS) has gained much popularity in the past few decades, and is now a mainstay of diagnostic decision-making. This expanded use is now highlighting the substantial issue of individual hospitals in credentialing its emergency medicine attending physicians in EUS in the United States. This issue is also of importance as more hospitals are now requesting reimbursements for emergency ultrasounds. The objective of this study is to gain an understanding of how many emergency departments are currently credentialing its attending staff in EUS, what the internal structure and staffing are of these emergency departments, and how they are currently performing quality assurance of the ultrasounds performed. METHODS This was a cross-sectional, web-based survey sent to 160 ACGME-accredited EM residency programs from July 2013 to November 2013. The survey consisted of 23 questions regarding: (1) number of emergency medicine attendings on staff, (2) presence of an EUS fellowship, (3) quality assurance (QA) process, and (4) current US credentialing process. RESULTS There was a 50 % response rate. Fifty percent of the total respondents (n = 40) had an EUS fellowship program. Of the sites with an EUS fellowship, 36 had EUS fellowship-trained attendings. Of the sites without an EUS fellowship, 19 had EUS fellowship-trained faculty, p ≤ 0.0001. Sites with an EUS fellowship had a greater percentage of staff credentialed to perform EUS as compared to sites with no EUS fellowship, p = 0.0161. All sites with an EUS fellowship had EUS-credentialed attendings. In sites with an EUS fellowship, 35 conducted a formal QA of ED performed EUS scans versus 22 at sites without an EUS fellowship, p = 0.003. CONCLUSIONS The survey results support hiring emergency attendings that have completed postgraduate training in emergency ultrasonography to aid in credentialing staff. This also seems to be helpful in completing a timelier QA of all ED ultrasounds.
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Affiliation(s)
- Devjani Das
- />Department of Emergency Medicine, Northwell Health-Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305 USA
| | - Monica Kapoor
- />Department of Emergency Medicine, Northwell Health-Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305 USA
| | - Cara Brown
- />Department of Emergency Medicine, Northwell Health-Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305 USA
| | - Afoma Ndubuisi
- />Department of Emergency Medicine, Northwell Health-Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305 USA
| | - Sanjey Gupta
- />Department of Emergency Medicine, Northwell Health-Franklin Hospital, 900 Franklin Ave, Valley Stream, NY 11580 USA
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Kang TL, Berona K, Elkhunovich MA, Medero-Colon R, Seif D, Chilstrom ML, Mailhot T. Web-based teaching in point-of-care ultrasound: an alternative to the classroom? ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2015; 6:171-175. [PMID: 25792863 PMCID: PMC4364591 DOI: 10.2147/amep.s72159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To evaluate two educational methods for point-of-care ultrasound (POC US) in order to: 1) determine participant test performance and attitudes in using POC US and 2) compare cost and preparation time to run the courses. METHODS This was a pilot study conducted at a county teaching hospital. Subjects were assigned to participate in either a large group course with live classroom lectures (Group A) or a group asked to watch 4.5 hours of online prerecorded lectures (Group B). Both groups participated in small-group hands-on training after watching the lectures. Both groups took a pre- and post-course exam, and completed course surveys. Cost and time spent running the courses were also compared. RESULTS Forty-seven physicians participated in the study. The pre-test and post-test scores between the two groups did not differ significantly. Of those with prior ultrasound experience, the majority of both groups preferred to continue classroom-based teaching for future courses. Interestingly, in the groups who had no ultrasound experience prior to their course participation, there was a higher percentage who preferred web-based teaching. Lastly, Group B was shown to have the potential to take less preparatory time when compared to Group A. CONCLUSION A web-based curriculum in POC US appears to be a promising and potentially time saving alternative to live classroom lectures and seems to offer similar educational benefits for the postgraduate learner.
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Affiliation(s)
- Tarina Lee Kang
- Department of Emergency Medicine, Los Angeles County and the University of Southern California (LAC + USC) Medical Center, Los Angeles, CA, USA
| | - Kristin Berona
- Department of Emergency Medicine, Los Angeles County and the University of Southern California (LAC + USC) Medical Center, Los Angeles, CA, USA
| | - Marsha A Elkhunovich
- Department of Emergency Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Roberto Medero-Colon
- Department of Emergency Medicine, Los Angeles County and the University of Southern California (LAC + USC) Medical Center, Los Angeles, CA, USA
| | - Dina Seif
- Department of Emergency Medicine, Los Angeles County and the University of Southern California (LAC + USC) Medical Center, Los Angeles, CA, USA
| | - Mikaela L Chilstrom
- Department of Emergency Medicine, Los Angeles County and the University of Southern California (LAC + USC) Medical Center, Los Angeles, CA, USA
| | - Tom Mailhot
- Department of Emergency Medicine, Los Angeles County and the University of Southern California (LAC + USC) Medical Center, Los Angeles, CA, USA
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Su E, Pustavoitau A. Pediatric critical care ultrasound education: the importance of a common denominator. Pediatr Crit Care Med 2015; 16:292-4. [PMID: 25738928 DOI: 10.1097/pcc.0000000000000342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Erik Su
- Department of Anesthesia and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
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