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Oto B, Baeten R, Chen L, Dalal P, Dancel R, Fox S, Lange IV CW, Baston C, Bornemann P, Dugar S, Goldsmith A, Herbst MK, Kirkpatrick JN, Koratala A, Lanspa MJ, Lobo V, Nomura JT, Pustavoitau A, Senussi MH, Sorrell VL, West FM, Sarwal A. Best Practices for Point of Care Ultrasound: An Interdisciplinary Expert Consensus. POCUS JOURNAL 2024; 9:95-108. [PMID: 38681157 PMCID: PMC11044939 DOI: 10.24908/pocus.v9i1.17240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Despite the growing use of point of care ultrasound (POCUS) in contemporary medical practice and the existence of clinical guidelines addressing its specific applications, there remains a lack of standardization and agreement on optimal practices for several areas of POCUS use. The Society of Point of Care Ultrasound (SPOCUS) formed a working group in 2022 to establish a set of recommended best practices for POCUS, applicable to clinicians regardless of their training, specialty, resource setting, or scope of practice. Using a three-round modified Delphi process, a multi-disciplinary panel of 22 POCUS experts based in the United States reached consensus on 57 statements in domains including: (1) The definition and clinical role of POCUS; (2) Training pathways; (3) Credentialing; (4) Cleaning and maintenance of POCUS devices; (5) Consent and education; (6) Security, storage, and sharing of POCUS studies; (7) Uploading, archiving, and reviewing POCUS studies; and (8) Documenting POCUS studies. The consensus statements are provided here. While not intended to establish a standard of care or supersede more targeted guidelines, this document may serve as a useful baseline to guide clinicians, leaders, and systems considering initiation or enhancement of POCUS programs.
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Affiliation(s)
- Brandon Oto
- Bridgeport Hospital, Yale New Haven HealthBridgeport, CTUSA
| | | | - Leon Chen
- Memorial Sloan Kettering Cancer CenterNew York, NYUSA
| | | | - Ria Dancel
- University of North Carolina at Chapel HillChapel Hill, NCUSA
| | - Steven Fox
- University of Alabama at BirminghamBirmingham, ALUSA
| | | | | | | | | | | | | | | | | | - Michael J Lanspa
- Intermountain Medical Center and the University of UtahMurray , UTUSA
| | - Viveta Lobo
- Stanford University School of MedicineStanford, CAUSA
| | | | | | | | - Vincent L. Sorrell
- Gill Heart and Vascular Institute, University of KentuckyLexington, KYUSA
| | | | - Aarti Sarwal
- Wake Forest University School of MedicineWinston-Salem, NCUSA
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Perez-Sanchez A, Jensen TP, Soni NJ. Clinical progress note: 5 Essential point-of-care ultrasound skills for hospitalists. J Hosp Med 2024; 19:304-311. [PMID: 38230881 DOI: 10.1002/jhm.13276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/09/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Ariadna Perez-Sanchez
- Department of Medicine, Division of Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Trevor P Jensen
- Department of Medicine, Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - Nilam J Soni
- Department of Medicine, Division of Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
- Medicine Service, Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas, USA
- Department of Medicine, Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
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Gaudreau-Simard M, Saiyin T, Mcinnes MDF, Ruller S, Clark EG, Wooller K, Kilabuk E, Forster AJ, Woo MY. Test characteristics of point-of-care ultrasonography in patients with acute kidney injury. Ultrasound J 2024; 16:15. [PMID: 38388747 PMCID: PMC10884383 DOI: 10.1186/s13089-023-00352-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/13/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Acute kidney injury is a common disorder that is associated with significant morbidity and mortality. Point-of-care ultrasonography (PoCUS) is an imaging modality performed at the bedside and is used to assess for obstructive causes of acute kidney injury. Little is known about the test characteristics of PoCUS in patients with acute kidney injury. OBJECTIVE Our primary objective was to describe the test characteristics of PoCUS for the detection of hydronephrosis in patients presenting with acute kidney injury at our centre. Our secondary objective was to describe the current rate of use of PoCUS for this indication. RESULTS In total, 7873 patients were identified between June 1, 2019 and April 30, 2021, with 4611 meeting inclusion criteria. Of these, 94 patients (2%) underwent PoCUS, and 65 patients underwent both PoCUS and reference standard, for a total of 124 kidneys included in our diagnostic accuracy analysis. The prevalence of hydronephrosis in our cohort was 33% (95% CI 25-41%). PoCUS had a sensitivity of 85% (95% CI 71-94%) and specificity of 78% (95% CI 68-87%) for the detection of hydronephrosis. CONCLUSION We describe the test characteristics of PoCUS for the detection of hydronephrosis in a cohort of patients with acute kidney injury. The low uptake of this test presents an opportunity for quality improvement work to increase its use for this indication.
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Affiliation(s)
- Mathilde Gaudreau-Simard
- Division of General Internal Medicine, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Tana Saiyin
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Matthew D F Mcinnes
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Diagnostic Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Sydney Ruller
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Edward G Clark
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Nephrology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Krista Wooller
- Division of General Internal Medicine, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Elaine Kilabuk
- Division of General Internal Medicine, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alan J Forster
- Division of General Internal Medicine, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Michael Y Woo
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
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Flamanc T, de Carvalho H, Le Bastard Q, Javaudin F, Pes P, Montassier E, Le Conte P. Impact of an enhanced focused cardiac ultrasound on treatment changes in a population of internal medicine patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:219-224. [PMID: 38031392 DOI: 10.1002/jcu.23617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Hospitalized patients with acute shortness of breath (SOB) could benefit from an enhanced focused cardiac ultrasound (eFoCUS) with Doppler measurements to reassess treatment and diagnosis. METHODS This was a retrospective observational study performed in a medical ward. Included patients were those hospitalized for acute SOB. The objectives were to assess therapeutic and diagnosis changes associated with eFoCUS. The primary endpoint of the analysis was a composite of introduction or discontinuation of diuretics, antibiotics or anticoagulation following eFoCUS. RESULTS Between January 2018 and July 2021, 119 patients were included, 67 women and 52 men, mean age 84 ± 11 years old. The eFoCUS was performed within a median time of 55 h (1st-3rd IQ: 21-107) following hospital admission. Overall, eFoCUS was associated with a change in diagnostic in 40 patients (34% [CI 95%: 25%-43%], p < 10-4 ) and a change in treatment in 53 patients (45% [CI 95%: 35%-54%], p < 10-4 ). Diuretics were prescribed in 94 patients before eFoCUS and in 56 after (p = 10-4 ), antibiotics in 34 before and 27 after and anticoagulation in 30 before and 40 after. CONCLUSION eFoCUS was associated with both therapeutic and diagnostic changes in patients with SOB. Such results should be confirmed in multicentric prospective studies.
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Affiliation(s)
| | | | - Quentin Le Bastard
- Service des Urgences, CHU de Nantes, Nantes, France
- Faculté de Médecine, Nantes Université, Nantes, France
| | - François Javaudin
- Service des Urgences, CHU de Nantes, Nantes, France
- Faculté de Médecine, Nantes Université, Nantes, France
| | - Philippe Pes
- Service des Urgences, CHU de Nantes, Nantes, France
| | - Emmanuel Montassier
- Service des Urgences, CHU de Nantes, Nantes, France
- Faculté de Médecine, Nantes Université, Nantes, France
| | - Philippe Le Conte
- Service des Urgences, CHU de Nantes, Nantes, France
- Faculté de Médecine, Nantes Université, Nantes, France
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Giangregorio F, Mosconi E, Debellis MG, Palermo E, Provini S, Mendozza M, Ricevuti L, Esposito C. Bedside Clinical Hand-held Ultrasound in an Internal Medicine Department: The "Bed Med-Us" Experience of Codogno and its Clinical Utility in the Management of Diagnosis and Therapy in 1007 Patients. Ultrasound Int Open 2024; 10:a21961599. [PMID: 38304447 PMCID: PMC10829908 DOI: 10.1055/a-2196-1599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/22/2023] [Indexed: 02/03/2024] Open
Abstract
Purpose Handheld ultrasound (HH-US) answers simple clinical questions in emergencies. We performed conventional US with HH-US at the patient's bedside (BED) during a medical visit (MED) (BED MED-US). The purpose of this prospective study is to estimate BED MED-US reliability, its clinical impact in helping the clinician to formulate correct diagnoses, and its ability to save time and money. Materials and Methods 1007 patients (519 M; age:76.42) were assessed (from March 2021 to November 2022) in one or more districts. Final diagnosis was determined with clinical and reference tests (chest RX/CT, abdominal CT, endoscopy, etc.). Sensitivity, specificity, LR+ and LR-, and corresponding AUROC were evaluated. HH-US diagnoses were classified as: confirmation (HH-US revealed the sonographic signs that confirmed the clinical diagnosis) (CO), exclusion (HH-US excluded the presence of the ultrasound signs of other pathologies, in the clinical differential diagnosis) (EX), etiological (HH-US reaches diagnosis in clinically doubtful cases) (ET), or clinically relevant incidental (HH-US diagnoses that change the patient's process completely) (INC). Results HH-US reliability: true-pos: 752; true-neg: 242; false-pos: 7; false-neg: 6 (sens: 99.1%, spec: 97.6%, LR+: 98.5; LR-: 00.15, AUROC: 0.997); clinical impact: CO-diagnosis: 21%; EX: 25%; ET: 47%; INC: 7%; saved time and money: approximately 35,572 minutes of work and 9324 euros. Conclusion BED MED-US is a reliable clinical imaging system, with an important clinical impact both in diagnosis (etiological in 47%, incidental in 7%) and in the management of personnel resources.
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Overgaard J, Thilagar BP, Bhuiyan MN. A Clinician's Guide to the Implementation of Point-of-Care Ultrasound (POCUS) in the Outpatient Practice. J Prim Care Community Health 2024; 15:21501319241255576. [PMID: 38773821 PMCID: PMC11113028 DOI: 10.1177/21501319241255576] [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: 02/22/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/24/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is a valuable clinical tool used at the patient bedside to rapidly assess a wide variety of symptoms and problems which would otherwise take hours or even days. Though it has become the standard of care in Emergency Medicine and is becoming so in hospital internal medicine, less uptake has been appreciated in the outpatient setting despite reported interest from clinicians practicing there. A number of common barriers have been cited to explain this gap in use, which usually include access to equipment, mentorship, and time. In this review we present a proposed framework for clinicians who have an interest in implementing POCUS in their outpatient practice which we hope can mitigate some of these barriers and provide a more streamlined pathway to their desired goals.
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Thomas MK, Conner SM, Maw A, Soni NJ. Point-counterpoint: Should point-of-care ultrasound be a required skill of hospitalists? J Hosp Med 2023; 18:1150-1155. [PMID: 37747100 DOI: 10.1002/jhm.13208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Meghan K Thomas
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephanie M Conner
- Division of Hospital Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anna Maw
- Division of Hospital Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Nilam J Soni
- Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas, USA
- Divisions of Hospital Medicine and Pulmonary Diseases and Critical Care Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
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Gardner TA, Breitbach EK, Limes JE, Connors GR, Berry AR, Longino AA, Shah S, Fainstad B, Miller TM, Ortiz-Lopez C, Fleshner M. A Quality Improvement Approach to Modification of a Point-of-Care Ultrasound Curriculum. ATS Sch 2023; 4:538-545. [PMID: 38196688 PMCID: PMC10773275 DOI: 10.34197/ats-scholar.2023-0018in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/29/2023] [Indexed: 01/11/2024] Open
Abstract
Background There is increasing emphasis on resident involvement in quality improvement (QI) efforts, yet resident engagement in QI has remained low for many reasons. Although QI methods are classically applied to clinical processes, there are many opportunities to incorporate QI principles into curricular design and implementation. Objective Demonstrate the utility of QI methods when applied to curricular design and the implementation of a novel point-of-care ultrasound portfolio development and quality assurance program at a large internal medicine residency program. Methods We applied foundational QI methods, including process mapping, plan-do-study-act (PDSA) cycles, time-trap identification, run-chart analysis, and qualitative interviews throughout the curricular design and implementation phases to rapidly identify areas for improvement and perform timely tests of change. Results Fifty-one interns participated in the curriculum, submitting 731 images in the first trimester. Process mapping and submission review revealed that 29% of images were saved to the incorrect digital archive. Resident-reviewer interpretation concordance was present in 80.7% of submissions. In 95.2% of completed quality assurance cards, the same information was provided in the commentary feedback and the evaluator's checklists, representing a time trap. Interventions included restricting access to image archives and removing redundant fields from quality assurance cards. The time to feedback fell from 69.5 to 6.5 days, demonstrating nonrandom variation via run-chart analysis. Conclusion This pilot study demonstrates the successful application of QI methods to a novel point-of-care ultrasound curriculum. The systematic use of these methodologies in curricular design and implementation allows expeditious curricular improvement. Emphasizing the relevance of QI methods to subject matter beyond clinical processes may increase resident engagement in QI efforts.
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Affiliation(s)
| | | | | | | | - Andrew R. Berry
- Division of Hospital Medicine, Rocky Mountain VA Medical Center
| | | | - Sneha Shah
- Division of Hospital Medicine, Rocky Mountain VA Medical Center
| | - Brandon Fainstad
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Tyler M. Miller
- Division of Hospital Medicine, Rocky Mountain VA Medical Center
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Dadon Z, Orlev A, Butnaru A, Rosenmann D, Glikson M, Gottlieb S, Alpert EA. Empowering Medical Students: Harnessing Artificial Intelligence for Precision Point-of-Care Echocardiography Assessment of Left Ventricular Ejection Fraction. Int J Clin Pract 2023; 2023:5225872. [PMID: 38078051 PMCID: PMC10699938 DOI: 10.1155/2023/5225872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/14/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction Point-of-care ultrasound (POCUS) use is now universal among nonexperts. Artificial intelligence (AI) is currently employed by nonexperts in various imaging modalities to assist in diagnosis and decision making. Aim To evaluate the diagnostic accuracy of POCUS, operated by medical students with the assistance of an AI-based tool for assessing the left ventricular ejection fraction (LVEF) of patients admitted to a cardiology department. Methods Eight students underwent a 6-hour didactic and hands-on training session. Participants used a hand-held ultrasound device (HUD) equipped with an AI-based tool for the automatic evaluation of LVEF. The clips were assessed for LVEF by three methods: visually by the students, by students + the AI-based tool, and by the cardiologists. All LVEF measurements were compared to formal echocardiography completed within 24 hours and were evaluated for LVEF using the Simpson method and eyeballing assessment by expert echocardiographers. Results The study included 88 patients (aged 58.3 ± 16.3 years). The AI-based tool measurement was unsuccessful in 6 cases. Comparing LVEF reported by students' visual evaluation and students + AI vs. cardiologists revealed a correlation of 0.51 and 0.83, respectively. Comparing these three evaluation methods with the echocardiographers revealed a moderate/substantial agreement for the students + AI and cardiologists but only a fair agreement for the students' visual evaluation. Conclusion Medical students' utilization of an AI-based tool with a HUD for LVEF assessment achieved a level of accuracy similar to that of cardiologists. Furthermore, the use of AI by the students achieved moderate to substantial inter-rater reliability with expert echocardiographers' evaluation.
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Affiliation(s)
- Ziv Dadon
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amir Orlev
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adi Butnaru
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - David Rosenmann
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shmuel Gottlieb
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Evan Avraham Alpert
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
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Tierney DM, Rosborough TK, Sipsey LM, Hanson K, Smith CS, Boland LL, Miner R. Association of Internal Medicine Point of Care Ultrasound (POCUS) with Length of Stay, Hospitalization Costs, and Formal Imaging: a Prospective Cohort Study. POCUS JOURNAL 2023; 8:184-192. [PMID: 38099159 PMCID: PMC10721304 DOI: 10.24908/pocus.v8i2.16791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Background: Point of care ultrasound (POCUS) use has rapidly expanded among internal medicine (IM) physicians in practice and residency training programs. Many benefits have been established; however, studies demonstrating the impact of POCUS on system metrics are few and mostly limited to the emergency department or intensive care setting. The study objective was to evaluate the impact of inpatient POCUS on patient outcomes and hospitalization metrics. Methods: Prospective cohort study of 12,399 consecutive adult admissions to 22 IM teaching attendings, at a quaternary care teaching hospital (7/1/2011-6/30/2015), with or without POCUS available during a given hospitalization. Multivariable regression and propensity score matching (PSM) analyses compared multiple hospital metric outcomes (costs, length of stay, radiology-based imaging, satisfaction, etc.) between the "POCUS available" vs. "POCUS unavailable" groups as well as the "POCUS available" subgroups of "POCUS used" vs. "POCUS not used". Results: Patients in the "POCUS available" vs. "POCUS unavailable" group had lower mean total and per-day hospital costs ($17,474 vs. $21,803, p<0.001; $2,805.88 vs. $3,557.53, p<0.001), lower total and per-day radiology cost ($705.41 vs. $829.12, p<0.001; $163.11 vs. $198.53, p<0.001), fewer total chest X-rays (1.31 vs. 1.55, p=0.01), but more chest CTs (0.22 vs 0.15; p=0.001). Mean length of stay (LOS) was 5.77 days (95% CI = 5.63, 5.91) in the "POCUS available" group vs. 6.08 95% CI (5.66, 6.51) in the "POCUS unavailable" group (p=0.14). Within the "POCUS available" group, cost analysis with a 4:1 PSM (including LOS as a covariate) compared patients receiving POCUS vs. those that could have but did not, and also showed total and per-day cost savings in the "POCUS used" subgroup ($15,082 vs. 15,746; p<0.001 and $2,685 vs. $2,753; p=0.04). Conclusions: Availability and selected use of POCUS was associated with a meaningful reduction in total hospitalization cost, radiology cost, and chest X-rays for hospitalized patients.
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Affiliation(s)
- David M Tierney
- Department of Graduate Medical Education, Abbott Northwestern HospitalMinneapolis, MNUSA
| | - Terry K Rosborough
- Department of Graduate Medical Education, Abbott Northwestern HospitalMinneapolis, MNUSA
| | - Lynn M Sipsey
- Department of Graduate Medical Education, Abbott Northwestern HospitalMinneapolis, MNUSA
| | - Kai Hanson
- Allina Health Care Delivery ResearchMinneapolis, MNUSA
| | | | - Lori L Boland
- Allina Health Care Delivery ResearchMinneapolis, MNUSA
| | - Robert Miner
- Department of Graduate Medical Education, Abbott Northwestern HospitalMinneapolis, MNUSA
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11
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Gupta PB, Lighthall G, Htet N. Use of Point-of-Care Ultrasound by Intensive Care Unit Triage Teams in Evaluating Unstable Patients Outside Intensive Care Units. Cureus 2023; 15:e49114. [PMID: 38125228 PMCID: PMC10732337 DOI: 10.7759/cureus.49114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction Point-of-care ultrasound (POCUS) has become an integral asset in intensive care units (ICUs). However, there is limited literature on the value of POCUS in evaluating deteriorating patients outside the ICU. In this study, we sought to investigate the use and impact of POCUS by ICU triage teams in hospitals outside of the ICU setting. Methods ICU triage fellows were provided a portable ultrasound to use as part of their evaluations during consultations and hospital code activations. Fellows were asked to fill out a survey on how ultrasound was used and its impact on patient management. Free-text data such as reason for ultrasound use, views obtained, clinical impressions before and after ultrasound, and clinical actions were recorded. These data were transcribed and categorized electronically. Results A total of 51 total resuscitations were documented. The most common reason for ICU triage team evaluation was hypotension (53%, N=27). The most common clinical focus for ultrasound use was cardiac assessment (53%, N=27), followed by volume status assessment (35%, N=18). The most common ultrasound views per encounter obtained were parasternal long (82%, N=42), followed by apical four-chamber view (76%, N=39) and subcostal view (75%, N=38). Out of 38 encounters with clinical impressions documented, 79% (N=30) of pre-ultrasound clinical impressions were confirmed by ultrasound use. Of total encounters, 35% (N=18) had a significant clinical action taken based on ultrasound findings (fluid resuscitation, vasopressor initiation, etc.). Conclusions Ultrasound is a valuable tool for patient evaluation in non-ICU wards, especially in confirming clinical impressions and guiding therapeutic actions. Some limitations of this study include reporting bias and incomplete capture of ultrasound use in non-ICU wards.
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Affiliation(s)
- Pranjal B Gupta
- Department of Emergency Medicine, Stanford University, Palo Alto, USA
| | - Geoffrey Lighthall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, USA
- Department of Anesthesia, Veterans Affairs Medical Center, Palo Alto, USA
| | - Natalie Htet
- Department of Emergency Medicine, Stanford University, Palo Alto, USA
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Lee JY, Conlon TW, Fraga MV, Bauer AJ, Soni NJ, Chen AE, Kaplan SL. Identifying commonalities in definition and governance of point-of-care ultrasound within statements from medical organizations in the United States: A scoping review for a shared understanding. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1622-1630. [PMID: 37850556 DOI: 10.1002/jcu.23574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/19/2023] [Indexed: 10/19/2023]
Abstract
This scoping review analyzed statements from 22 medical organizations in the United States to identify commonalities in the definition and governance of point-of-care ultrasound (POCUS). A total of 41 statements were included. The review found that the most commonly used elements in defining POCUS were "focused," "bedside," and "patient care." In terms of governance, consistent requirements included specific training programs, documentation in medical records, continuous quality assurance, and standards for credentialing and privileging. These findings suggest the existence of essential commonalities that could facilitate communication and the development of standardized POCUS programs in the future.
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Affiliation(s)
- Jeong-Yong Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas W Conlon
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria V Fraga
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew J Bauer
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nilam J Soni
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Aaron E Chen
- Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Summer L Kaplan
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Sun H, Wu A, Lu M, Cao S. Liability, risks, and recommendations for ultrasound use in the diagnosis of obstetrics diseases. Heliyon 2023; 9:e21829. [PMID: 38045126 PMCID: PMC10692788 DOI: 10.1016/j.heliyon.2023.e21829] [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] [Received: 08/05/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
This literature review will summarize the liability issues, risks, and ultrasound recommendations for diagnosing obstetrics diseases. One liability issue is related to misdiagnosis or failure to detect abnormalities during an ultrasound examination. Ultrasound images can be subjective interpretations, and errors may occur due to factors such as operator skill, equipment limitations, or fetal positioning. Another liability concern is related to the potential adverse effects of ultrasound exposure on both the mother and fetus. While extensive research has shown that diagnostic ultrasound is generally safe when used appropriately, there are still uncertainties regarding long-term effects. Some studies suggest a possible association between prolonged or excessive exposure to ultrasound waves and adverse outcomes such as low birth weight, developmental delays, or hearing impairment. Additionally, obtaining informed consent from patients is crucial in mitigating liability risks. Patients should be informed about the purpose of the ultrasound examination, its benefits, limitations, potential risks (even if minimal), and any alternative diagnostic options available. This ensures that patients know the procedure and can make informed decisions about their healthcare. Proper documentation helps establish a clear record of the care provided and can serve as evidence in any legal disputes.
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Affiliation(s)
- Haiting Sun
- Department of Ultrasound, The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, 315700, Zhejiang Province, PR China
| | - An Wu
- Department of Ultrasound, The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, 315700, Zhejiang Province, PR China
| | - Minli Lu
- Department of Ultrasound, The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, 315700, Zhejiang Province, PR China
| | - Shan Cao
- Department of Obstetrics, The Affiliated Second People's Hospital of Yuhang District, Hangzhou City, Hangzhou, 311100, Zhejiang Province, PR China
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14
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Yamada T, Minami T, Kitano Y, Yoshino S, Mabuchi S, Soni NJ. Development of a national point-of-care ultrasound training course for physicians in Japan: A 3-year evaluation. MEDEDPUBLISH 2023; 13:223. [PMID: 38303735 PMCID: PMC10831232 DOI: 10.12688/mep.19679.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 02/03/2024] Open
Abstract
Purpose: Point-of-care ultrasound (POCUS) allows bedside clinicians to acquire, interpret, and integrate ultrasound images into patient care. Although the availability of POCUS training courses has increased, the educational effectiveness of these courses is unclear. Methods: From 2017 to 2019, we investigated the educational effectiveness of a standardized 2-day hands-on POCUS training course and changes in pre- and post-course exam scores in relationship to participants' (n = 571) clinical rank, years of POCUS experience, and frequency of POCUS use in clinical practice. Results: The mean pre- and post-course examination scores were 67.2 (standard deviation [SD] 12.3) and 79.7 (SD 9.7), respectively. Higher pre-course examination scores were associated with higher clinical rank, more years of POCUS experience, and more frequent POCUS use (p < 0.05). All participants showed significant changes in pre- to post-course exam scores. Though pre-course scores differed by clinical rank, POCUS experience, and frequency of POCUS use, differences in post-course scores according to participant baseline differences were non-significant. Conclusion: A standardized hands-on POCUS training course is effective for improving POCUS knowledge regardless of baseline differences in clinical rank, POCUS experience, or frequency of POCUS use. Future studies shall evaluate changes in POCUS use in clinical practice after POCUS training.
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Affiliation(s)
- Toru Yamada
- General Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, 279-0001, Japan
- General Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Taro Minami
- Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, 02903, USA
- Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Care New England Health System, Providence, Rhode Island, USA
| | - Yuka Kitano
- Emergency and Critical Care Medicine, St. Marianna University, School of Medicine, Kawasaki, Kanagawa, 216-8511, Japan
| | - Shunpei Yoshino
- General Internal Medicine, Iizuka Byoin, Iizuka, Fukuoka Prefecture, 135-0041, Japan
| | - Suguru Mabuchi
- General Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Nilam J. Soni
- Medicine, Division of Hospital Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, 78229, USA
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15
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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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16
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Chen LL, Tayban K, Tomicich J, Buchholz T, Barzola M, Mead E, Halpern NA. Point-of-care Ultrasound (POCUS) Program for Critical Care Nurse Practitioners and Physician Assistants in an Oncological Intensive Care Unit and Rapid Response Team. J Am Assoc Nurse Pract 2023:01741002-990000000-00159. [PMID: 37646585 DOI: 10.1097/jxx.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Indexed: 09/01/2023]
Abstract
ABSTRACT Implementation of a comprehensive point-of-care ultrasound (POCUS) program for nurse practitioners (NPs) and physician assistants (PAs) in an intensive care unit (ICU) setting improves their diagnostic and therapeutic skills and enhances patient care. Overcoming staffing, IT infrastructure, and administrative challenges has allowed our critical care medicine service to develop a successful program that empowers NPs and PAs and boosts their professional growth. Our POCUS program underscores the necessity of institutional support, dedicated mentorship, collaboration with qualified faculty, and creation and maintenance of a curriculum that adheres to accepted national guidelines. Insights gained from our experiences can serve as a valuable resource for institutions aiming to develop their own POCUS programs.
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Affiliation(s)
- Leon L Chen
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Columbia University School of Nursing, New York, New York
| | - Kate Tayban
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joanna Tomicich
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tara Buchholz
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa Barzola
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elena Mead
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Neil A Halpern
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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17
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Finn EM, Zwemer EK, Stephens JR, Dancel R. The State of Internal Medicine Point-of-Care Ultrasound (POCUS) Fellowships in the United States and Canada. Am J Med 2023; 136:830-836. [PMID: 37116671 DOI: 10.1016/j.amjmed.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/22/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Erin M Finn
- Department of Internal Medicine; Department of Pediatrics, Division of Hospital Medicine, University of North Carolina, Chapel Hill.
| | - Eric K Zwemer
- Department of Pediatrics, Division of Hospital Medicine, University of North Carolina, Chapel Hill
| | - John R Stephens
- Department of Internal Medicine; Department of Pediatrics, Division of Hospital Medicine, University of North Carolina, Chapel Hill
| | - Ria Dancel
- Department of Internal Medicine; Department of Pediatrics, Division of Hospital Medicine, University of North Carolina, Chapel Hill
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18
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Walsh MH, Smyth LM, Desy JR, Fischer EA, Goffi A, Li N, Lee M, St‐Pierre J, Ma IWY. Lung ultrasound: A comparison of image interpretation accuracy between curvilinear and phased array transducers. Australas J Ultrasound Med 2023; 26:150-156. [PMID: 37701767 PMCID: PMC10493348 DOI: 10.1002/ajum.12347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Introduction Both curvilinear and phased array transducers are commonly used to perform lung ultrasound (LUS). This study seeks to compare LUS interpretation accuracy of images obtained using a curvilinear transducer with those obtained using a phased array transducer. Methods We invited 166 internists and trainees to interpret 16 LUS images/cineloops of eight patients in an online survey: eight curvilinear and eight phased array, performed on the same lung location. Images depicted normal lung, pneumothorax, pleural irregularities, consolidation/hepatisation, pleural effusions and B-lines. Primary outcome for each participant is the difference in image interpretation accuracy scores between the two transducers. Results A total of 112 (67%) participants completed the survey. The mean paired accuracy score difference between the curvilinear and phased array images was 3.0% (95% CI: 0.6 to 5.4%, P = 0.015). For novices, scores were higher on curvilinear images (mean difference: 5.4%, 95% CI: 0.9 to 9.9%, P = 0.020). For non-novices, there were no differences between the two transducers (mean difference: 1.4%, 95% CI: -1.1 to 3.9%, P = 0.263). For pleural-based findings, the mean of the paired differences between transducers was higher in the novice group (estimated mean difference-in-differences: 9.5%, 95% CI: 0.6 to 18.4%; P = 0.036). No difference in mean accuracies was noted between novices and non-novices for non-pleural-based pathologies (estimated mean difference-in-differences: 0.6%, 95% CI to 5.4-6.6%; P = 0.837). Conclusions Lung ultrasound images obtained using the curvilinear transducer are associated with higher interpretation accuracy than the phased array transducer. This is especially true for novices interpreting pleural-based pathologies.
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Affiliation(s)
- Michael H. Walsh
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Leo M. Smyth
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Janeve R. Desy
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Ernest A. Fischer
- Division of Hospital Medicine, Department of MedicineMedStar Georgetown University HospitalWashingtonDistrict of ColumbiaUSA
| | - Alberto Goffi
- Interdepartmental Division of Critical Care Medicine and Department of MedicineUniversity of TorontoTorontoOntarioCanada
- St. Michael's Hospital and Li Ka Shing Knowledge Institute, Keenan Research CentreUnity Health TorontoTorontoOntarioCanada
| | - Na Li
- Department of Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Matthew Lee
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Joëlle St‐Pierre
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Irene W. Y. Ma
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
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19
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Smalley CM, Simon EL, Muir MR, Fertel BS. A Real-World Experience: Retrospective Review of Point-of-Care Ultrasound Utilization and Quality in Community Emergency Departments. West J Emerg Med 2023; 24:685-692. [PMID: 37527388 PMCID: PMC10393449 DOI: 10.5811/westjem.58965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/24/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION Point-of-care ultrasound (POCUS) is commonly used in the emergency department (ED) as a rapid diagnostic tool. Emergency medicine (EM) has been an early adopter of POCUS with indications expanding over the last 10 years. While the literature describes widespread use among academic sites, there is little data on clinical POCUS utilization at non-academic EDs. We sought to describe community emergency physician (EP) use of POCUS by quantifying the number and type of studies performed, characteristics of the performing physician, and quality metrics. METHODS Prior to the study period, all EPs underwent a standardized training and credentialing program. A retrospective review of all POCUS studies across 11 non-academic EDs from October 1, 2018-September 30, 2020 was performed by fellowship-trained physicians, who identified physician, exam type, and residency graduation year. The studies were then cross-referenced with quality review reports that assessed image acquisition, image interpretation, and image labeling. We performed descriptive statistics. RESULTS During the study period, 5,099 POCUS studies were performed by 170 EPs. Exams most frequently performed were cardiac (24%), focused assessment of sonography in trauma (21.7%), and pregnancy (16.2%). Recent EM residency graduates (<10 years) were higher utilizers of POCUS with a group mean of 1.3 exams per 100 patients. Of the studies done, 86% had no quality issues. CONCLUSION Community POCUS demonstrates a heavy focus on core exams performed by recent EM residency graduates with minimal quality issues after a standardized training program. This study is the first to quantify actual community POCUS use in multiple EDs and may impact credentialing and skills maintenance requirements.
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Affiliation(s)
- Courtney M Smalley
- Cleveland Clinic Health System, Emergency Services Institute, Cleveland, Ohio
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Erin L Simon
- Cleveland Clinic Akron General, Department of Emergency Medicine, Akron, Ohio
- Northeast Ohio Medical University, Rootstown, Ohio
| | - McKinsey R Muir
- Cleveland Clinic Health System, Emergency Services Institute, Cleveland, Ohio
| | - Baruch S Fertel
- Columbia University Vagelos College of Physicians and Surgeons, Department of Emergency Medicine, New York, New York
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20
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Polyzogopoulou E, Velliou M, Verras C, Ventoulis I, Parissis J, Osterwalder J, Hoffmann B. Point-of-Care Ultrasound: A Multimodal Tool for the Management of Sepsis in the Emergency Department. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1180. [PMID: 37374384 DOI: 10.3390/medicina59061180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023]
Abstract
Sepsis and septic shock are life-threatening emergencies associated with increased morbidity and mortality. Hence, early diagnosis and management of both conditions is of paramount importance. Point-of-care ultrasound (POCUS) is a cost-effective and safe imaging modality performed at the bedside, which has rapidly emerged as an excellent multimodal tool and has been gradually incorporated as an adjunct to physical examination in order to facilitate evaluation, diagnosis and management. In sepsis, POCUS can assist in the evaluation of undifferentiated sepsis, while, in cases of shock, it can contribute to the differential diagnosis of other types of shock, thus facilitating the decision-making process. Other potential benefits of POCUS include prompt identification and control of the source of infection, as well as close haemodynamic and treatment monitoring. The aim of this review is to determine and highlight the role of POCUS in the evaluation, diagnosis, treatment and monitoring of the septic patient. Future research should focus on developing and implementing a well-defined algorithmic approach for the POCUS-guided management of sepsis in the emergency department setting given its unequivocal utility as a multimodal tool for the overall evaluation and management of the septic patient.
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Affiliation(s)
- Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
| | - Maria Velliou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
| | - Christos Verras
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
- National Centre of Emergency Care (EKAB), 11527 Athens, Greece
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, 50200 Ptolemaida, Greece
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
| | | | - Beatrice Hoffmann
- Department of Emergency Medicine BIDMC, One Deaconess Rd, WCC2, Boston, MA 02215, USA
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21
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Dhamija A, Perry LA, OConnor TJ, Ulland L, Slavik E, Towbin AJ. Development and Implementation of a Semi-Automated Workflow for Point-of-Care Ultrasound Billing and Documentation Within an Electronic Health Record. J Digit Imaging 2023; 36:395-400. [PMID: 36385677 PMCID: PMC10039213 DOI: 10.1007/s10278-022-00742-4] [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: 09/14/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 11/17/2022] Open
Abstract
Point-of-care ultrasound (POCUS) is widely used for both diagnostic and therapeutic purposes. With its many advantages, including ease of use, real-time multisystem assessment, affordability, availability, and accuracy, it has been adopted by all medical specialties. Despite its advantages, the lack of standard workflow and automated billing solutions makes it difficult to launch a comprehensive POCUS program. In this work, we describe how we created and implemented an efficient standardized EHR-based workflow for POCUS that has been used across multiple division and settings within our organization.
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Affiliation(s)
- Akhil Dhamija
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Laurie A Perry
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Timothy J OConnor
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Lisa Ulland
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Evan Slavik
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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22
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Gaudreau-Simard M, Kilabuk E, Halman S, Wooller K, Woo MY, Arntfield R, Ma I, Forster AJ. Start spreading the news: a deliberate approach to POCUS program development and implementation. Ultrasound J 2023; 15:13. [PMID: 36892686 PMCID: PMC9998745 DOI: 10.1186/s13089-023-00309-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/31/2023] [Indexed: 03/10/2023] Open
Abstract
While there is an expanding body of literature on Point-of-Care Ultrasound (POCUS) pedagogy, administrative elements that are necessary for the widespread adoption of POCUS in the clinical environment have received little attention. In this short communication, we seek to address this gap by sharing our institutional experience with POCUS program development and implementation. The five pillars of our program, selected to tackle local barriers to POCUS uptake, are education, workflow, patient safety, research, and sustainability. Our program logic model outlines the inputs, activities, and outputs of our program. Finally, key indicators for the monitoring of program implementation efforts are presented. Though designed for our local context, this approach may readily be adapted toward other clinical environments. We encourage others leading the integration of POCUS at their centers to adopt this approach not only to achieve sustainable change but also to ensure that quality safeguards are in place.
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Affiliation(s)
- Mathilde Gaudreau-Simard
- Division of General Internal Medicine, Department of Medicine, The Ottawa Civic Hospital, University of Ottawa, 1053 Carling Ave, D 107, Box 209, Ottawa, ON, K1Y 4E9, Canada.
- The Ottawa Hospital Research Institute, The Ottawa Hospital, 725 Parkdale Ave, Ottawa, ON, K1y 4E9, Canada.
| | - Elaine Kilabuk
- Division of General Internal Medicine, Department of Medicine, The Ottawa General Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1Y 4E9, Canada
| | - Samantha Halman
- The Ottawa Hospital Research Institute, The Ottawa Hospital, 725 Parkdale Ave, Ottawa, ON, K1y 4E9, Canada
- Division of General Internal Medicine, Department of Medicine, The Ottawa General Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1Y 4E9, Canada
| | - Krista Wooller
- Division of General Internal Medicine, Department of Medicine, The Ottawa Civic Hospital, University of Ottawa, 1053 Carling Ave, D 107, Box 209, Ottawa, ON, K1Y 4E9, Canada
- The Ottawa Hospital Research Institute, The Ottawa Hospital, 725 Parkdale Ave, Ottawa, ON, K1y 4E9, Canada
| | - Michael Y Woo
- The Ottawa Hospital Research Institute, The Ottawa Hospital, 725 Parkdale Ave, Ottawa, ON, K1y 4E9, Canada
- Department of Emergency Medicine, The Ottawa Civic Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - Robert Arntfield
- Division of Critical Care, London Health Sciences Center, Victoria Hospital, Western University, 800 Commissioners Road East, Room D2 521A, London, ON, N6A 5W9, Canada
| | - Irene Ma
- Division of General Internal Medicine, Department of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Department of Community Health Sciences, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Alan J Forster
- Division of General Internal Medicine, Department of Medicine, The Ottawa Civic Hospital, University of Ottawa, 1053 Carling Ave, D 107, Box 209, Ottawa, ON, K1Y 4E9, Canada
- The Ottawa Hospital Research Institute, The Ottawa Hospital, 725 Parkdale Ave, Ottawa, ON, K1y 4E9, Canada
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23
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Johri AM, Glass C, Hill B, Jensen T, Puentes W, Olusanya O, Capizzano JN, Dancel R, Reierson K, Reisinger N, Liblik K, Galen BT. The Evolution of Cardiovascular Ultrasound: A Review of Cardiac Point-of-Care Ultrasound (POCUS) Across Specialties. Am J Med 2023:S0002-9343(23)00158-4. [PMID: 36889497 DOI: 10.1016/j.amjmed.2023.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023]
Abstract
The use of cardiac point-of-care ultrasound (POCUS) is now widespread in clinics, emergency departments, and all areas of the hospital. Users include medical trainees, advanced practice practitioners, and attending physicians in many specialties and sub-specialties. Opportunities to learn cardiac POCUS and requirements for training vary across specialties as does the scope of the cardiac POCUS examination. In this review, we describe both a brief history of how cardiac POCUS emerged from echocardiography and the state of the art across a variety of medical fields.
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Affiliation(s)
- Amer M Johri
- Department of Medicine, Queen's University, Kingston, ON, Canada.
| | - Casey Glass
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Braeden Hill
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Trevor Jensen
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Wilfredo Puentes
- Department of Anesthesia, Western University, London, ON, Canada
| | - Olusegun Olusanya
- Department of Critical Care, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | | | - Ria Dancel
- Departments of Internal Medicine and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Kreegan Reierson
- Department of Hospital Medicine, HealthPartners Medical Group, Minnesota and Wisconsin, USA
| | - Nathaniel Reisinger
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Kiera Liblik
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Benjamin T Galen
- Department of Internal Medicine, Division of Hospital Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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24
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Tullo G, Candelli M, Gasparrini I, Micci S, Franceschi F. Ultrasound in Sepsis and Septic Shock-From Diagnosis to Treatment. J Clin Med 2023; 12:jcm12031185. [PMID: 36769833 PMCID: PMC9918257 DOI: 10.3390/jcm12031185] [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: 12/18/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED Sepsis and septic shock are among the leading causes of in-hospital mortality worldwide, causing a considerable burden for healthcare. The early identification of sepsis as well as the individuation of the septic focus is pivotal, followed by the prompt initiation of antibiotic therapy, appropriate source control as well as adequate hemodynamic resuscitation. For years now, both emergency department (ED) doctors and intensivists have used ultrasound as an adjunctive tool for the correct diagnosis and treatment of these patients. Our aim was to better understand the state-of-the art role of ultrasound in the diagnosis and treatment of sepsis and septic shock. METHODS We conducted an extensive literature search about the topic and reported on the data from the most significant papers over the last 20 years. RESULTS We divided each article by topic and exposed the results accordingly, identifying four main aspects: sepsis diagnosis, source control and procedure, fluid resuscitation and hemodynamic optimization, and echocardiography in septic cardiomyopathy. CONCLUSION The use of ultrasound throughout the process of the diagnosis and treatment of sepsis and septic shock provides the clinician with an adjunctive tool to better characterize patients and ensure early, aggressive, as well as individualized therapy, when needed. More data are needed to conclude that the use of ultrasound might improve survival in this subset of patients.
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25
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Anstey J, Jensen T, Lalani F, Conner SM. Teaching the Teachers: A Flexible, Cognitive-Focused Curriculum in Point-of-Care Ultrasound Education for Hospital Medicine Faculty. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3103-3111. [PMID: 36063066 DOI: 10.1002/jum.16091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/08/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES We aimed to decrease barriers to acquiring Point-of-Care Ultrasound (POCUS) knowledge among attending physicians and improve the safety of trainee POCUS use through a novel flexible and cognitive based curriculum. METHODS We developed three educational pathways using varied approaches to educational delivery: a novel and asynchronous cognitive curriculum to allow Educational Supervision, a hands-on pathway for Limited Practice, and a more robust pathway for Independent Practice and credentialing. RESULTS From November 2018 through June 2021, 102 of 116 hospitalists engaged in some portion of the curriculum. Twenty-four completed the Educational Supervision pathway, 31 completed the Limited Practice pathway, and 17 enrolled in the Independent Practice pathway with three achieving independent practice. Faculty who completed the Educational Supervision pathway had improved scores on a comprehensive POCUS knowledge assessment, 43.5% [95% Confidence Interval (CI) 38.2-48.8] versus 72.0% [95% CI 65.2-78.8], P < .001. Junior faculty were more likely to engage in the supervision pathway and senior faculty were more likely to complete an intensive course to complete the Limited Practice pathway. CONCLUSIONS A flexible, cognitive focused POCUS curriculum was effective in creating high levels of engagement, and a cognitive only curriculum resulted in significant improvement in hospitalists' POCUS knowledge without hands on training. Finally, we found that hospitalist engagement in the curriculum did not follow the lowest barrier to entry or time commitment and engagement varied by time in practice. Training faculty to independent practice remains a substantial challenge.
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Affiliation(s)
- James Anstey
- Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, California, USA
- Department of Medicine, Division of Hospital Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Trevor Jensen
- Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, California, USA
| | - Farhan Lalani
- Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, California, USA
- Department of Medicine, Division of Hospital Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Stephanie McCarty Conner
- Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, California, USA
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Muacevic A, Adler JR. RUSHing to the Diagnosis: Aortic Abdominal Aneurysm Detected Using the Rapid Ultrasound for Shock and Hypotension (RUSH) Protocol in the Wards. Cureus 2022; 14:e32565. [PMID: 36540318 PMCID: PMC9754670 DOI: 10.7759/cureus.32565] [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: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
The rapid ultrasound for shock and hypotension (RUSH) protocol is a useful tool used in the emergency department (ED) when addressing the severity and etiology of shock. It was designed to be performed in under two minutes with evaluation of the pump (heart), tank (inferior vena cava, thoracic and abdominal compartments) and the pipes (large arteries and veins). However, its application or one similar should extend beyond the ED and into the hospital floor. Here we present an 80-year-old gentleman with a history of atrial fibrillation (A-Fib) on anticoagulation who arrived at the ED due to an episode of pre-syncope just prior to arrival. Initial EKG is concerning for A-Fib with rapid ventricular response (RVR) with a rate in the 130s. After fluid resuscitation patient improved and he was admitted to the telemetry floor for further cardiac workup and cardiology consultation. While waiting for a room in the ED, patient became hypotensive, diaphoretic and pale. After complaining of lower abdominal pain, the ED physician performed a RUSH which showed an abdominal aorta of 8 cm concerning for dissection. Diagnosis was confirmed with CT angiography of the abdomen and he was taken to the OR with successful repair of the abdominal aortic aneurysm (AAA). Patient made meaningful recovery and was discharged to in-patient rehab. The patient described in this vignette was delayed in the ED due to lack of beds on the floor. This allowed for quick ultrasound work-up by the ED physician which led to immediate recognition of the AAA and immediate response by the vascular surgery team. Should this patient have been on the hospital floor, it is unclear if such prompt steps would have occurred prior to patient's further hemodynamic demise.
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Ross DW, Moses AA, Niyyar VD. Point-of-care ultrasonography in nephrology comes of age. Clin Kidney J 2022; 15:2220-2227. [PMID: 36381376 PMCID: PMC9664573 DOI: 10.1093/ckj/sfac160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Indexed: 03/22/2024] Open
Abstract
The physical exam is changing. Many have argued that the physical exam of the 21st century should include point-of-care ultrasound (POCUS). POCUS is being taught in medical schools and has been endorsed by the major professional societies of internal medicine. In this review we describe the trend toward using POCUS in medicine and describe where the practicing nephrologist fits in. We discuss what a nephrologist's POCUS exam should entail and we give special attention to what nephrologists can gain from learning POCUS. We suggest a 'nephro-centric' approach that includes not only ultrasound of the kidney and bladder, but of the heart, lungs and vascular access. We conclude by reviewing some of the sparse data available to guide training initiatives and give suggested next steps for advancing POCUS in nephrology.
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Affiliation(s)
- Daniel W Ross
- Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Division of Kidney Diseases and Hypertension, Great Neck, NY, USA
| | - Andrew A Moses
- Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lenox Hill Division of Nephrology, New York, NY, USA
| | - Vandana Dua Niyyar
- Emory University, Division of Nephrology, Woodruff Memorial Research Building, Atlanta GA, USA
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Arichai P, Delaney M, Slamowitz A, Rosario R, Gordish-Dressman H, Basu S, Kern J, Maxwell A, Abo A. Pediatric Residency Point-of-Care Ultrasound Training Needs Assessment and Educational Intervention. Cureus 2022; 14:e28696. [PMID: 36204025 PMCID: PMC9527041 DOI: 10.7759/cureus.28696] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 11/06/2022] Open
Abstract
Background Prior studies showed that point-of-care ultrasound (POCUS) training is not commonly offered in pediatric residency. We assessed the need for a pediatric POCUS curriculum by evaluating pediatric trainees’ attitudes toward the use of POCUS and identifying barriers to training. We also aimed to evaluate the impact of a POCUS educational intervention on self-efficacy and behavior. Methods We conducted a cross-sectional survey of pediatric residents in a single large freestanding children’s hospital distributed via an institutional listserv and administered online. The survey included opinion-rating of statements regarding POCUS and barriers to training. We also offered a two-week POCUS course with online modules and hands-on scanning. Participating residents completed pre- and post-course knowledge assessments and follow-up surveys up to 12 months following the course to assess POCUS use and self-report confidence on POCUS indications, acquisition, interpretation, and clinical application. Results Forty-nine respondents were included in the survey representing all three pediatric levels with 16 specialty interest areas. Ninety-six percent of trainees reported that POCUS is an important skill in pediatrics. Ninety-two percent of trainees reported that residency programs should teach residents how to use POCUS. The most important perceived barriers to POCUS training were scheduling availability for POCUS rotations and lack of access to an ultrasound machine. Fourteen participants completed the pre- and post-course knowledge tests, with eight and six participants also completing the six- and 12-month follow-up surveys, respectively. Self-ratings of confidence were significantly improved post-intervention in indications (P = 0.007), image acquisition (P = 0.002), interpretation (P = 0.002), and clinical application (P = 0.004). This confidence improvement was sustained up to 6-12 months (P = 0.004-0.032). Participants also reported higher categorical POCUS use after course completion (P = 0.031). Conclusions Pediatric trainees perceive POCUS as an important skill, hold favorable opinions towards the use of POCUS, and support POCUS training within a pediatric residency. A POCUS course can improve resident POCUS knowledge, instill confidence, and motivate higher POCUS use. Further study is needed to evaluate POCUS applications in pediatric medicine to develop a standardized POCUS curriculum and establish a training guideline for pediatric residency.
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Carrera KG, Hassen G, Camacho-Leon GP, Rossitto F, Martinez F, Debele TK. The Benefits and Barriers of Using Point-of-Care Ultrasound in Primary Healthcare in the United States. Cureus 2022; 14:e28373. [PMID: 36171847 PMCID: PMC9508689 DOI: 10.7759/cureus.28373] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/08/2022] Open
Abstract
An effective healthcare system should embrace practices that enhance overall quality and productivity. Training primary care physicians in Point-of-Care Ultrasound (POCUS) has become part of the processes that improve the quality of patient care and serve to guide the diagnostic impression quickly and effectively. With the purpose of highlighting the applications and challenges of POCUS use in US primary health care, we conducted a narrative review based on PubMed-indexed and Cochrane Library English text publications searched in May-July 2022 using a combination of key terms including point of care ultrasound, primary care, and US healthcare. Many studies have shown that POCUS has a positive impact on fostering medical attention and reducing morbidity, mortality, and healthcare costs. Besides assisting in procedures, POCUS has a head-to-toe application in evaluating inflammatory and infectious conditions, acute abdomen, cardiopulmonary function, musculoskeletal and vascular pathologies. However, its uniform implementation is limited across the US healthcare system due to multitudes of barriers such as lack of training, resource scarcity, and low reimbursement. Training primary care physicians in general and emergency care providers, in particular, is key to scaleup POCUS use. Large size studies are paramount to further explore the effectiveness of POCUS and identify key challenges to its implementation.
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Mans PA, Yogeswaran P, Adeniyi OV. Protocol for a Delphi Consensus Study to Determine the Essential and Optional Ultrasound Skills for Medical Practitioners Working in District Hospitals in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9640. [PMID: 35954999 PMCID: PMC9367781 DOI: 10.3390/ijerph19159640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/18/2022] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
With increasing access to point of care ultrasound (POCUS) at district hospitals in South Africa, there is a lack of standardisation of skillsets among medical practitioners working at this level of care. This study protocol aims to use the Delphi process to achieve expert consensus on the essential and optional ultrasound skills required for medical practitioners working in district hospitals in South Africa. In alignment with the Delphi method, several iterative rounds will be implemented from June to November 2022. Purposive sampling will be conducted, through the recruitment of two representatives from each academic department of family medicine and two medical doctors working in district hospitals in each province in the country (N = 36). The POCUS skillsets published by the American Academy of Family Physicians will be circulated in the first iterative round, following which participants may suggest further additions. Once a consensus target of 70% has been achieved, the Delphi process will be finalised. The Delphi process and data analysis will be facilitated by an online Delphi platform. Findings from the study will provide insight into the design of the curriculum for POCUS training for medical practitioners in district hospitals and registrars in family medicine departments across the country.
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Affiliation(s)
- Pierre-Andre Mans
- Department of Family Medicine, Cecilia Makiwane Hospital, Mdantsane, East London 5201, South Africa
- Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5117, South Africa
| | - Parimalaranie Yogeswaran
- Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5117, South Africa
- Department of Family Medicine, Mthatha Regional Hospital, Mthatha 5100, South Africa
| | - Oladele Vincent Adeniyi
- Department of Family Medicine, Cecilia Makiwane Hospital, Mdantsane, East London 5201, South Africa
- Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5117, South Africa
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Lung Ultrasound in Heart Failure: Envisioning Handheld Ultrasound to Empower Nurses and Transform Health Care. J Am Coll Cardiol 2022; 80:524-526. [PMID: 35902176 DOI: 10.1016/j.jacc.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022]
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Blaivas M, Blaivas LN, Campbell K, Thomas J, Shah S, Yadav K, Liu YT. Making Artificial Intelligence Lemonade Out of Data Lemons: Adaptation of a Public Apical Echo Database for Creation of a Subxiphoid Visual Estimation Automatic Ejection Fraction Machine Learning Algorithm. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2059-2069. [PMID: 34820867 DOI: 10.1002/jum.15889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES A paucity of point-of-care ultrasound (POCUS) databases limits machine learning (ML). Assess feasibility of training ML algorithms to visually estimate left ventricular ejection fraction (EF) from a subxiphoid (SX) window using only apical 4-chamber (A4C) images. METHODS Researchers used a long-short-term-memory algorithm for image analysis. Using the Stanford EchoNet-Dynamic database of 10,036 A4C videos with calculated exact EF, researchers tested 3 ML training permeations. First, training on unaltered Stanford A4C videos, then unaltered and 90° clockwise (CW) rotated videos and finally unaltered, 90° rotated and horizontally flipped videos. As a real-world test, we obtained 615 SX videos from Harbor-UCLA (HUCLA) with EF calculations in 5% ranges. Researchers performed 1000 randomizations of EF point estimation within HUCLA EF ranges to compensate for ML and HUCLA EF mismatch, obtaining a mean value for absolute error (MAE) comparison and performed Bland-Altman analyses. RESULTS The ML algorithm EF mean MAE was estimated at 23.0, with a range of 22.8-23.3 using unaltered A4C video, mean MAE was 16.7, with a range of 16.5-16.9 using unaltered and 90° CW rotated video, mean MAE was 16.6, with a range of 16.3-16.8 using unaltered, 90° CW rotated and horizontally flipped video training. Bland-Altman showed weakest agreement at 40-45% EF. CONCLUSIONS Researchers successfully adapted unrelated ultrasound window data to train a POCUS ML algorithm with fair MAE using data manipulation to simulate a different ultrasound examination. This may be important for future POCUS algorithm design to help overcome a paucity of POCUS databases.
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Affiliation(s)
- Michael Blaivas
- Department of Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
- Department of Emergency Medicine, St. Francis Hospital, Columbus, GA, USA
| | | | - Kendra Campbell
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Joseph Thomas
- Department of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sonia Shah
- Department of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kabir Yadav
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yiju Teresa Liu
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Ritter E, Qayyum R. Restoring "bedside" in the bedside procedures. J Hosp Med 2022; 17:673-674. [PMID: 35855518 DOI: 10.1002/jhm.12916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 06/25/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Evan Ritter
- Division of Hospital Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Rehan Qayyum
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Williams JP, Nathanson R, LoPresti CM, Mader MJ, Haro EK, Drum B, O'Brien E, Khosla R, Boyd JS, Bales B, Wetherbee E, Sauthoff H, Schott CK, Basrai Z, Resop D, Lucas BP, Soni NJ. Current use, training, and barriers in point-of-care ultrasound in hospital medicine: A national survey of VA hospitals. J Hosp Med 2022; 17:601-608. [PMID: 35844080 DOI: 10.1002/jhm.12911] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/18/2022] [Accepted: 05/29/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) can reduce procedural complications and improve the diagnostic accuracy of hospitalists. Currently, it is unknown how many practicing hospitalists use POCUS, which applications are used most often, and what barriers to POCUS use exist. OBJECTIVE This study aimed to characterize current POCUS use, training needs, and barriers to use among hospital medicine groups (HMGs). DESIGN, SETTING, AND PARTICIPANTS A prospective observational study of all Veterans Affairs (VA) medical centers was conducted between August 2019 and March 2020 using a web-based survey sent to all chiefs of HMGs. These data were compared to a similar survey conducted in 2015. RESULT Chiefs from 117 HMGs were surveyed, with a 90% response rate. There was ongoing POCUS use in 64% of HMGs. From 2015 to 2020, procedural POCUS use decreased by 19%, but diagnostic POCUS use increased for cardiac (8%), pulmonary (7%), and abdominal (8%) applications. The most common barrier to POCUS use was lack of training (89%), and only 34% of HMGs had access to POCUS training. Access to ultrasound equipment was the least common barrier (57%). The proportion of HMGs with ≥1 ultrasound machine increased from 29% to 71% from 2015 to 2020. An average of 3.6 ultrasound devices per HMG was available, and 45% were handheld devices. CONCLUSION From 2015 to 2020, diagnostic POCUS use increased, while procedural use decreased among hospitalists in the VA system. Lack of POCUS training is currently the most common barrier to POCUS use among hospitalists.
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Affiliation(s)
- Jason P Williams
- Medical Education, Atlanta VA Medical Center, Medicine Service, Atlanta, Georgia, USA
- Division of Hospital Medicine, Emory School of Medicine, Atlanta, Georgia, USA
| | - Robert Nathanson
- Department of Medicine, South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas, USA
- Division of General & Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Charles M LoPresti
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Michael J Mader
- Department of Medicine, South Texas Veterans Health Care System, Research Service, San Antonio, Texas, USA
| | - Elizabeth K Haro
- Department of Medicine, South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas, USA
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Brandy Drum
- Department of Veterans Affairs, Healthcare Analysis and Information Group, Milwaukee, Wisconsin, USA
| | - Edward O'Brien
- Department of Veterans Affairs, Healthcare Analysis and Information Group, Milwaukee, Wisconsin, USA
| | - Rahul Khosla
- Department of Pulmonary, Critical Care and Sleep Medicine, George Washington University Medical Faculty Associates, Washington, District of Columbia, USA
- Pulmonary and Critical Care Medicine, Washington Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - Jeremy S Boyd
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Emergency Medicine, VA Tennessee Valley Healthcare System-Nashville, Nashville, Tennessee, USA
| | - Brian Bales
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Emergency Medicine, VA Tennessee Valley Healthcare System-Nashville, Nashville, Tennessee, USA
| | - Erin Wetherbee
- Pulmonary Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Harald Sauthoff
- Medicine Service, VA NY Harbor Healthcare System, New York, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, New York, USA
| | - Christopher K Schott
- Critical Care Service, VA Pittsburgh Health Care Systems, Pittsburgh, Pennsylvania, USA
- Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zahir Basrai
- Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Dana Resop
- Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin, USA
- Emergency Department, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Brian P Lucas
- Medicine Service, White River Junction VA Medical Center, White River Junction, Vermont, USA
- Department of Medicine, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Nilam J Soni
- Department of Medicine, South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas, USA
- Division of General & Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
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Lammers S, Dolin CD, Baston C. A Call for Development of Point-of-Care Ultrasound Training Recommendations in Obstetrics and Gynecology Residency. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1845-1848. [PMID: 34694027 DOI: 10.1002/jum.15853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 06/13/2023]
Abstract
Point-of-care ultrasound (POCUS) skillsets are now taught throughout training levels from medical school through fellowship given the broad utility in assisting with bedside procedures and triaging clinical presentations for expedited workup. This is reflected in training curricula for emergency medicine, internal medicine, and general surgery residencies. However, these skillsets are not formally taught or required in obstetrics and gynecology residency. We present the opinion that these skillsets and curricula should be developed for obstetrics and gynecology trainees given their exposure to patients with similar clinical presentations in which the clinical management would be aided by POCUS.
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Affiliation(s)
- Stephen Lammers
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Cara D Dolin
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Cameron Baston
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Development of a Point-of-Care Ultrasound Track for Internal Medicine Residents. J Gen Intern Med 2022; 37:2308-2313. [PMID: 35713808 PMCID: PMC9205286 DOI: 10.1007/s11606-022-07505-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/23/2022] [Indexed: 10/25/2022]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) training has been increasing among internal medicine (IM) residency programs, but few programs can provide longitudinal training due to barriers such as lack of trained faculty. AIM Describe the development of a longitudinal POCUS track for IM residents using local and external resources, including a national POCUS certificate program. SETTING University-based IM residency program affiliated with a public and veterans affairs hospital. PARTICIPANTS Twelve IM residents from 2018 to 2021. PROGRAM DESCRIPTION Residents complete a national POCUS certificate program by attending live courses and completing online modules, an image portfolio, and final knowledge/skills assessments. Locally, residents participate in 1-month procedure and diagnostic POCUS rotations and provide peer-to-peer POCUS teaching of residents and medical students. PROGRAM EVALUATION The POCUS track increased residents' use and comfort with diagnostic and procedural applications. All residents rated being satisfied or very satisfied with the track and would recommend it to prospective applicants (100%). The most commonly reported barriers to utilizing POCUS per residents were time constraints (83%), lack of available ultrasound equipment (83%), and lack of trained faculty (58%). DISCUSSION IM residency programs with limited faculty expertise in POCUS can leverage external resources to provide longitudinal POCUS training to its residents.
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Ahern BJ, Falconi AE. Glenohumeral joint effusion assessment with point-of-care ultrasound. JAAPA 2022; 35:60-62. [PMID: 35762959 DOI: 10.1097/01.jaa.0000830212.09348.c7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Ultrasound has favorable diagnostic accuracy for detecting glenohumeral joint effusions. This article describes an easy-to-learn and interpret limited glenohumeral joint ultrasound examination that can help guide further evaluation and treatment. We report on a patient ultimately diagnosed with septic arthritis of the glenohumeral joint, the associated joint effusion having been detected on bedside ultrasound. This ultrasound examination is applicable to generalist PAs and those working in orthopedics and acute care settings.
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Affiliation(s)
- Brian J Ahern
- Brian J. Ahern practices in emergency medicine at William Beaumont Army Medical Center in El Paso, Tex. Audrey E. Falconi practices at Madigan Army Medical Center at Joint Base Lewis-McChord in Washington State. The views expressed in this article are those of the authors and do not reflect the official policy of William Beaumont Army Medical Center, the Department of Army, the Defense Health Agency, or the US government. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Sattin M, Burhani Z, Jaidka A, Millington SJ, Arntfield RT. Stroke Volume Determination by Echocardiography. Chest 2022; 161:1598-1605. [PMID: 35085589 DOI: 10.1016/j.chest.2022.01.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 01/31/2023] Open
Abstract
Basic critical care echocardiography emphasizes two-dimensional (2D) findings, such as ventricular function, inferior vena cava size, and pericardial assessment, while generally excluding quantitative findings and Doppler-based techniques. Although this approach offers advantages, including efficiency and expedited training, it complicates attempts to understand the hemodynamic importance of any 2D abnormalities detected. Stroke volume (SV), as the summative event of the cardiac cycle, is the most pragmatic available indicator through which a clinician can rapidly determine, no matter the 2D findings, whether aberrant cardiac physiology is contributing to the state of shock. An estimate of SV allows 2D findings to be placed into better context in terms of both hemodynamic significance and acuity. This article describes the technique of SV determination, reviews common confounding factors and pitfalls, and suggests a systematic approach for using SV measurements to help integrate important 2D findings into the clinical context.
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Affiliation(s)
| | - Zain Burhani
- University of Western Ontario, London, ON, Canada
| | - Atul Jaidka
- University of Western Ontario, London, ON, Canada
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Limes J, Gottenborg E, Anstett T, Brandenburg S, Diaz MJ, Glasheen JJ. A Novel Hospital Medicine Training Track for Internal Medicine Residents: Description and Program Evaluation of the First 15 Years. J Grad Med Educ 2022; 14:318-325. [PMID: 35754625 PMCID: PMC9200261 DOI: 10.4300/jgme-d-21-00730.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/23/2021] [Accepted: 02/25/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The growth of hospital medicine has resulted in a parallel growth of hospital medicine training within internal medicine residency programs (IMRPs), but the experience and outcomes of these training offerings have not yet been described. OBJECTIVE To describe the first dedicated hospitalist track and the program evaluation data. METHODS The University of Colorado Hospitalist Training Track (HTT) is a 3-year track within the IMRP with robust inpatient clinical training, specialized didactics, experiential improvement work, and career mentorship. We collected data on graduates' current practices and board certification pass rates. To further evaluate the track, we electronically sent a cross-sectional survey to 124 graduates from 2005 to 2019 to identify current practice settings, graduate roles, and assessment of the training track. RESULTS Among 124 graduates, 97 (78.2%) practice hospital medicine, and the board certification pass rate was slightly higher than the overall IMRP pass rate for those graduating classes. Sixty-two (50%) graduates responded to the survey. Among respondents, 50 (80.6%) currently practice hospital medicine and 34 (54.8%) practice in an academic setting. The majority (50, 80.6%) hold leadership roles and are involved in a variety of scholarship, educational, and operational projects. Dedicated clinical training, didactics, and mentorship were valued by respondents. CONCLUSIONS This represents the first description and program evaluation of a HTT for IM residents. A dedicated HTT produces graduates who choose hospital medicine careers at high rates and participate in a wide variety of leadership and nonclinical roles.
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Affiliation(s)
- Julia Limes
- All authors are with the University of Colorado School of Medicine
- Julia Limes, MD, is Assistant Professor of Medicine, Program Co-Director, Hospitalist Training Program, and Associate Program Director, Internal Medicine Residency Program, Division of Hospital Medicine, Department of Medicine
| | - Emily Gottenborg
- All authors are with the University of Colorado School of Medicine
- Emily Gottenborg, MD, is Assistant Professor of Medicine, Program Co-Director, Hospitalist Training Program, and Assistant Program Director, Internal Medicine Residency Program, Division of Hospital Medicine, Department of Medicine
| | - Tyler Anstett
- All authors are with the University of Colorado School of Medicine
- Tyler Anstett, DO, is Assistant Professor of Medicine and Core Faculty, Hospitalist Training Program, Division of Hospital Medicine, Department of Medicine
| | - Suzanne Brandenburg
- All authors are with the University of Colorado School of Medicine
- Suzanne Brandenburg, MD, is Professor of Medicine and Prior Program Director, Internal Medicine Residency Program, Division of Hospital Medicine, Department of Medicine
| | - Manuel J. Diaz
- All authors are with the University of Colorado School of Medicine
- Manuel J. Diaz, MD, is Assistant Professor of Medicine and Core Faculty, Hospitalist Training Program, Division of Hospital Medicine, Department of Medicine
| | - Jeffrey J. Glasheen
- All authors are with the University of Colorado School of Medicine
- Jeffrey J. Glasheen, MD, is Professor of Medicine and Prior Program Director, Hospitalist Training Program, Division of Hospital Medicine, Department of Medicine
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Affiliation(s)
- Hamid Shokoohi
- Division of Emergency Ultrasound, Department of Emergency Medicine, Massachusetts General Hospital, Boston.,Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Andrew S Liteplo
- Division of Emergency Ultrasound, Department of Emergency Medicine, Massachusetts General Hospital, Boston.,Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Irene W Y Ma
- Division of Emergency Ultrasound, Department of Emergency Medicine, Massachusetts General Hospital, Boston.,Division of General Internal Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Bernstein E, Wang TY. Point-of-Care Ultrasonography: Clearly More Than a Pretty Picture-Reply. JAMA Intern Med 2022; 182:568. [PMID: 35285852 DOI: 10.1001/jamainternmed.2022.0073] [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: 11/14/2022]
Affiliation(s)
- Eden Bernstein
- Cleveland Clinic Community Care, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Tracy Y Wang
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
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Lynch DH, Spangler HB, Franz JR, Krupenevich RL, Kim H, Nissman D, Zhang J, Li YY, Sumner S, Batsis JA. Multimodal Diagnostic Approaches to Advance Precision Medicine in Sarcopenia and Frailty. Nutrients 2022; 14:nu14071384. [PMID: 35405997 PMCID: PMC9003228 DOI: 10.3390/nu14071384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 12/12/2022] Open
Abstract
Sarcopenia, defined as the loss of muscle mass, strength, and function with aging, is a geriatric syndrome with important implications for patients and healthcare systems. Sarcopenia increases the risk of clinical decompensation when faced with physiological stressors and increases vulnerability, termed frailty. Sarcopenia develops due to inflammatory, hormonal, and myocellular changes in response to physiological and pathological aging, which promote progressive gains in fat mass and loss of lean mass and muscle strength. Progression of these pathophysiological changes can lead to sarcopenic obesity and physical frailty. These syndromes independently increase the risk of adverse patient outcomes including hospitalizations, long-term care placement, mortality, and decreased quality of life. This risk increases substantially when these syndromes co-exist. While there is evidence suggesting that the progression of sarcopenia, sarcopenic obesity, and frailty can be slowed or reversed, the adoption of broad-based screening or interventions has been slow to implement. Factors contributing to slow implementation include the lack of cost-effective, timely bedside diagnostics and interventions that target fundamental biological processes. This paper describes how clinical, radiographic, and biological data can be used to evaluate older adults with sarcopenia and sarcopenic obesity and to further the understanding of the mechanisms leading to declines in physical function and frailty.
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Affiliation(s)
- David H. Lynch
- Division of Geriatric Medicine, Center for Aging and Health, University of North Carolina, Chapel Hill, NC 27599, USA;
- Correspondence: ; Tel.: +919-966-5945; Fax: +919-962-9795
| | - Hillary B. Spangler
- Division of Medicine and Pediatrics, University of North Carolina, Chapel Hill, NC 27599, USA;
| | - Jason R. Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, North Carolina State University, Chapel Hill, NC 27599, USA; (J.R.F.); (R.L.K.); (H.K.)
| | - Rebecca L. Krupenevich
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, North Carolina State University, Chapel Hill, NC 27599, USA; (J.R.F.); (R.L.K.); (H.K.)
| | - Hoon Kim
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, North Carolina State University, Chapel Hill, NC 27599, USA; (J.R.F.); (R.L.K.); (H.K.)
| | - Daniel Nissman
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA; (D.N.); (J.Z.)
| | - Janet Zhang
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA; (D.N.); (J.Z.)
| | - Yuan-Yuan Li
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (Y.-Y.L.); (S.S.)
| | - Susan Sumner
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (Y.-Y.L.); (S.S.)
| | - John A. Batsis
- Division of Geriatric Medicine, Center for Aging and Health, University of North Carolina, Chapel Hill, NC 27599, USA;
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (Y.-Y.L.); (S.S.)
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Smith CJ, Barron K, Shope RJ, Beam E, Piro K. Motivations, barriers, and professional engagement: a multisite qualitative study of internal medicine faculty's experiences learning and teaching point-of-care ultrasound. BMC MEDICAL EDUCATION 2022; 22:171. [PMID: 35279153 PMCID: PMC8918294 DOI: 10.1186/s12909-022-03225-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) graduate medical education is expanding across many specialties, but a lack of trained faculty is a common barrier. Even well-designed faculty development programs struggle with retention, yet little is known about the experiences of practicing physicians learning POCUS. Our objective is to explore the experiences of clinician-educators as they integrate POCUS into their clinical and teaching practices to help inform curriculum design. METHODS Qualitative study using instrumental case study design to analyze interview data from 18 internal medicine clinician-educators at 3 academic health centers. Interviewees were recruited by program directors at each site to include participants with a range of POCUS use patterns. Interviews took place from July-August 2019. RESULTS Analysis yielded 6 themes: teaching performance, patient care, curriculum needs, workflow and access, administrative support, and professional engagement. Participants felt POCUS enhanced their teaching skills, clinical decision making, and engagement with patients. The themes highlighted the importance of longitudinal supervision and feedback, streamlined integration of POCUS into clinical workflow, and administrative support of time and resources. Interviewees reported learning and teaching POCUS helped combat burn-out and enhance their sense of professional engagement. CONCLUSIONS Learning POCUS as a practicing clinician-educator is a complicated endeavor that must take into account mastery of psychomotor skills, existing practice habits, and local institutional concerns. Based upon the themes generated from this study, we make recommendations to help guide POCUS faculty development curriculum design. Although this study focused on internists, the findings are likely generalizable to other specialties with growing interest in POCUS education.
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Affiliation(s)
- Christopher J Smith
- Department of Internal Medicine, Division of Hospital Medicine, University of Nebraska Medical Center, 986430 Nebraska Medical Center, Omaha, NE, USA.
| | - Keith Barron
- Prisma Health Midlands - University of South Carolina School of Medicine, Department of Internal Medicine, Division of General Internal Medicine, 14 Richland Medical Park Drive, Suite, Columbia, SC, 320, USA
| | - Ronald J Shope
- Department of Health Promotion, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, USA
| | - Elizabeth Beam
- Interprofessional Academy of Educators, University of Nebraska Medical Center, 987115 Nebraska Medical Center, Omaha, NE, USA
| | - Kevin Piro
- Department of Internal Medicine, Division of Hospital Medicine, Oregon Health & Science University, 3270 SW Pavilion Loop Suite, Portland, OR, 350, USA
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Janjigian M, Dembitzer A, Srisarajivakul-Klein C, Mednick A, Hardower K, Cooke D, Zabar S, Sauthoff H. Design and comparison of a hybrid to a traditional in-person point-of-care ultrasound course. Ultrasound J 2022; 14:12. [PMID: 35278145 PMCID: PMC8917361 DOI: 10.1186/s13089-022-00261-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background Traditional introductory point-of-care ultrasound (POCUS) courses are resource intensive, typically requiring 2–3 days at a remote site, consisting of lectures and hands-on components. Social distancing requirements resulting from the COVID-19 pandemic led us to create a novel hybrid course curriculum consisting of virtual and in-person components. Methods Faculty, chief residents, fellows and advanced practice providers (APPs) in the Department of Medicine were invited to participate in the hybrid curriculum. The course structure included 4 modules of recorded lectures, quizzes, online image interpretation sessions, online case discussions, and hands-on sessions at the bedside of course participant’s patients. The components of the course were delivered over approximately 8 months. Those participants who completed a minimum of 3 modules over the year were invited for final assessments. Results from the hybrid curriculum cohort were compared to the year-end data from a prior traditional in-person cohort. Results Participant knowledge scores were not different between traditional (n = 19) and hybrid (n = 24) groups (81% and 84%, respectively, P = 0.9). There was no change in POCUS skills as measured by the hands-on test from both groups at end-of-course (76% and 76%, respectively, P = 0.93). Confidence ratings were similar across groups from 2.73 traditional to 3.0 hybrid (out of possible 4, P = 0.46). Participants rated the course highly, with an average overall rating of 4.6 out 5. Conclusions A hybrid virtual and in-person POCUS course was highly rated and as successful as a traditional course in improving learner knowledge, hands-on skill and confidence at 8 months after course initiation. These results support expanding virtual elements of POCUS educational curricula. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-022-00261-x.
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Affiliation(s)
- Michael Janjigian
- Department of Medicine, New York University Grossman School of Medicine, NYC Health & Hospitals/Bellevue, Bellevue Hospital Center, New York, USA.
| | - Anne Dembitzer
- Department of Medicine, New York University Grossman School of Medicine, NY Harbor Healthcare System, New York, USA
| | - Caroline Srisarajivakul-Klein
- Department of Medicine, New York University Grossman School of Medicine, NYC Health & Hospitals/Bellevue, Bellevue Hospital Center, New York, USA
| | - Aron Mednick
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, USA
| | - Khemraj Hardower
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, USA
| | - Deborah Cooke
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, USA
| | - Sondra Zabar
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, USA
| | - Harald Sauthoff
- Department of Medicine, New York University Grossman School of Medicine, NY Harbor Healthcare System, New York, USA
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45
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Breunig M, Huckabee M, Rieck KM. An Integrated Point-of-Care Ultrasound Curriculum: An Evidence-Based Approach. J Physician Assist Educ 2022; 33:41-46. [PMID: 35067591 DOI: 10.1097/jpa.0000000000000402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Point-of-care ultrasound (POCUS) has been demonstrated to improve students' medical knowledge and clinical exam skills and advances patient care through numerous diagnostic and therapeutic applications. Despite the growing use of ultrasound in medical education and clinical practice, few physician assistant (PA) programs have successfully integrated POCUS education into their curricula. This manuscript describes an evidence-based approach for integrating POCUS education throughout a 2-year PA curriculum, with the goal of serving as a useful guidepost for other PA programs as they strive to incorporate this valuable skill into their curricula.
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Affiliation(s)
- Michael Breunig
- Michael Breunig, MPAS, PA-C, is the clinical skills co-director of the Mayo Clinic Physician Assistant Program and a hospitalist at the Mayo Clinic, Division of Hospital Internal Medicine, in Rochester, Minnesota
- Michael Huckabee, PhD, PA-C, is director of the Mayo Clinic Physician Assistant Program, Mayo Clinic School of Health Sciences, in Rochester, Minnesota
- Katie M. Rieck, MD, MHA, is medical director of the Mayo Physician Assistant Program and a hospitalist at the Mayo Clinic, Division of Hospital Internal Medicine, in Rochester, Minnesota
| | - Michael Huckabee
- Michael Breunig, MPAS, PA-C, is the clinical skills co-director of the Mayo Clinic Physician Assistant Program and a hospitalist at the Mayo Clinic, Division of Hospital Internal Medicine, in Rochester, Minnesota
- Michael Huckabee, PhD, PA-C, is director of the Mayo Clinic Physician Assistant Program, Mayo Clinic School of Health Sciences, in Rochester, Minnesota
- Katie M. Rieck, MD, MHA, is medical director of the Mayo Physician Assistant Program and a hospitalist at the Mayo Clinic, Division of Hospital Internal Medicine, in Rochester, Minnesota
| | - Katie M Rieck
- Michael Breunig, MPAS, PA-C, is the clinical skills co-director of the Mayo Clinic Physician Assistant Program and a hospitalist at the Mayo Clinic, Division of Hospital Internal Medicine, in Rochester, Minnesota
- Michael Huckabee, PhD, PA-C, is director of the Mayo Clinic Physician Assistant Program, Mayo Clinic School of Health Sciences, in Rochester, Minnesota
- Katie M. Rieck, MD, MHA, is medical director of the Mayo Physician Assistant Program and a hospitalist at the Mayo Clinic, Division of Hospital Internal Medicine, in Rochester, Minnesota
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LoPresti CM, Schnobrich D, Novak W, Fondahn E, Bardowell R, O'Connor AB, Uthlaut B, Ortiz J, Soni NJ. Current Point of Care Ultrasound Use and Training Among Internal Medicine Residency Programs from the 2020 APDIM Program Director's Survey. Am J Med 2022; 135:397-404. [PMID: 34890562 DOI: 10.1016/j.amjmed.2021.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/17/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Charles M LoPresti
- Section of Acute Medicine, Medicine Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Ohio; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Daniel Schnobrich
- Department of General Internal Medicine, University of Minnesota School of Medicine, Minneapolis
| | - William Novak
- Department of Medicine, University of Rochester School of Medicine and Dentistry, NY
| | - Emily Fondahn
- Department of Medicine, Washington University School of Medicine, St. Louis, Mo
| | - Rachel Bardowell
- Department of Medicine, Washington University School of Medicine, St. Louis, Mo
| | - Alec B O'Connor
- Department of Medicine, University of Rochester School of Medicine and Dentistry, NY
| | - Brian Uthlaut
- Department of Medicine, University of Virginia Health System, Charlottesville
| | - Jordan Ortiz
- Alliance for Academic Internal Medicine, Alexandria, Va
| | - Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Tex
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Algodi M, Wolfe DS, Taub CC. The Utility of Maternal Point of Care Ultrasound on Labor and Delivery Wards. J Cardiovasc Dev Dis 2022; 9:jcdd9010029. [PMID: 35050239 PMCID: PMC8777988 DOI: 10.3390/jcdd9010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 12/10/2022] Open
Abstract
Point-of-care ultrasonography (POCUS) refers to limited bedside ultrasound used to evaluate patients for conditions specific to the scope of their practice. Given the benefits of its application, interest in its use is increasing. We aimed to review the literature and assess the potential feasibility of using POCUS of the heart and lungs in the field of obstetrics. We aim to describe its relevance and value as an adjunctive tool for critically ill obstetric patients on labor and delivery wards.
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Affiliation(s)
- Mohammed Algodi
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA;
| | - Diana S. Wolfe
- Department of Obstetrics and Gynecology and Women’s Health, Division of Maternal Fetal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA;
| | - Cynthia C. Taub
- Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
- Correspondence:
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McGinness A, Lin-Martore M, Addo N, Shaahinfar A. The unmet demand for point-of-care ultrasound among general pediatricians: a cross-sectional survey. BMC MEDICAL EDUCATION 2022; 22:7. [PMID: 34980087 PMCID: PMC8722332 DOI: 10.1186/s12909-021-03072-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is a noninvasive bedside tool with many pediatric applications but is not currently a formal part of pediatric training and practice. Formal surveys of general pediatricians regarding POCUS training are lacking. We aimed to quantify the baseline ultrasound experience and training needs of general pediatricians and pediatric residents across different practice settings. METHODS In 2020, we sent an online survey to 485 current faculty, residents, and graduates from an urban pediatric academic medical center in Northern California. Pediatric subspecialists were excluded. Survey questions about baseline experience, comfort, and perceived usefulness of 20 common POCUS applications were developed by two POCUS experts using existing literature. Chi-squared analysis was used to compare residents versus attendings and to compare attendings practicing in inpatient versus outpatient versus mixed settings. RESULTS Response rate was 20% (98/485). Compared to attendings (n = 73), residents (n = 25) endorsed more exposure to POCUS in medical school (32% vs 5%, p = 0.003) and residency (12% vs 5%, p = 0.003). Respondents endorsed low comfort with POCUS (mean 1.3 out of 5 on Likert scale). Of 20 procedural and diagnostic applications, respondents identified abscess drainage, bladder catheterization, soft tissue, neck, advanced abdominal, and constipation as most useful. Overall, 50% of pediatricians (and 70% of pediatric residents) responded that there were opportunities to use POCUS multiple times a week or more in their clinical practice. CONCLUSIONS There is an unmet demand for POCUS training among general pediatricians and trainees in our study. Although the majority of respondents were not POCUS users, our results could guide future efforts to study the role of POCUS in general pediatrics and develop pediatric curricula.
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Affiliation(s)
- Anelah McGinness
- Department of Graduate Medical Education, PGY-3 resident, University of California San Francisco Benioff Children’s Hospital Oakland, 747 52nd Street, Suite 245, Oakland, CA 94609 USA
| | - Margaret Lin-Martore
- Departments of Emergency Medicine and Pediatrics, University of California San Francisco, 5150 16th St, Box 0632, San Francisco, CA 94143 USA
| | - Newton Addo
- Departments of Medicine and Emergency Medicine, 1001 Potrero Ave, Box 1220, San Francisco, CA 94143 USA
| | - Ashkon Shaahinfar
- Departments of Emergency Medicine and Pediatrics, University of California San Francisco Benioff Children’s Hospital Oakland, University of California San Francisco, 747 52nd Street, ED Trailer 3, Oakland, CA 94609 USA
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Holden MS, Portillo A, Salame G. Skills Classification in Cardiac Ultrasound with Temporal Convolution and Domain Knowledge Using a Low-Cost Probe Tracker. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3002-3013. [PMID: 34344562 DOI: 10.1016/j.ultrasmedbio.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/29/2021] [Accepted: 06/17/2021] [Indexed: 06/13/2023]
Abstract
As point-of-care ultrasound (POCUS) becomes more integrated into clinical practice, it is essential to address all aspects of ultrasound operator proficiency. Ultrasound proficiency requires the ability to acquire, interpret and integrate bedside ultrasound images. The difference in image acquisition psychomotor skills between novice (trainee) and expert (instructor) ultrasonographer has not been described. We created an inexpensive system, called Probe Watch, to record probe motion and assess image acquisition in cardiac POCUS using an inertial measurement device and software for data recording based on open-source components. We designed a temporal convolutional network for skills classification from probe motion that integrates clinical domain knowledge. We further designed data augmentation methods to improve its generalization. Subsequently, we validated the setup and assessment method on a set of novice and expert sonographers performing cardiac ultrasound in a simulation-based training environment. The proposed methods classified participants as novice or expert with areas under the receiver operating characteristic curve of 0.931 and 0.761 for snippets and trials, respectively. Integrating domain knowledge into the neural network had added value. Furthermore, we identified the most discriminative features for assessment. Probe Watch quantifies motion during cardiac ultrasound and provides insight into probe motion behavior. It may be deployed during cardiac ultrasound training to monitor learning curves objectively and automatically.
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Affiliation(s)
- Matthew S Holden
- School of Computer Science, Carleton University, Ottawa, Ontario, Canada.
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Leo M. Potential for Point-of-Care Ultrasonography to Improve Patient Care in Diagnosis of Dyspnea. Ann Intern Med 2021; 174:1016-1017. [PMID: 33900799 DOI: 10.7326/m21-1773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Megan Leo
- Boston University School of Medicine Boston, Massachusetts
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