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Resop DM, Basrai Z, Boyd JS, Williams JP, Nathanson R, Mader MJ, Haro EK, Drum B, O'Brien E, Khosla R, Bales B, Wetherbee E, Sauthoff H, Schott CK, Soni NJ. Current use, training, and barriers in point-of-care ultrasound in emergency departments in 2020: A National Survey of VA hospitals. Am J Emerg Med 2023; 63:142-146. [PMID: 36182580 DOI: 10.1016/j.ajem.2022.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Dana M Resop
- Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA; Emergency Department, William S. Middleton Memorial Veterans Hospital, Madison, WI, 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.
| | - Jeremy S Boyd
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, TN, USA; VA Tennessee Valley Healthcare System-Nashville, Department of Emergency Medicine, Nashville, TN, USA.
| | - Jason P Williams
- Atlanta VA Medical Center, Medicine Service, Atlanta, GA, USA; Emory School of Medicine, Division of Hospital Medicine, Atlanta, GA, USA.
| | - Robert Nathanson
- South Texas Veterans Health Care System, Medicine Service, San Antonio, TX, USA; University of Texas Health San Antonio, Division of Hospital Medicine, San Antonio, TX, USA.
| | - Michael J Mader
- South Texas Veterans Health Care System, Research Service, San Antonio, TX, USA.
| | - Elizabeth K Haro
- South Texas Veterans Health Care System, Medicine Service, San Antonio, TX, USA; University of Texas Health San Antonio, Division of Hospital Medicine, San Antonio, TX, USA.
| | - Brandy Drum
- Healthcare Analysis and Information Group, Department of Veterans Affairs, Milwaukee, WI, USA.
| | - Edward O'Brien
- Healthcare Analysis and Information Group, Department of Veterans Affairs, Milwaukee, WI, USA.
| | - Rahul Khosla
- Department of Pulmonary, Critical Care and Sleep Medicine, The George Washington University, Washington, DC, USA; Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Washington, DC, USA.
| | - Brian Bales
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, TN, USA; VA Tennessee Valley Healthcare System-Nashville, Department of Emergency Medicine, Nashville, TN, USA.
| | - Erin Wetherbee
- Pulmonary Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
| | - Harald Sauthoff
- Medicine Service, VA NY Harbor Healthcare System, New York, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, NY, New York, USA.
| | - Christopher K Schott
- VA Pittsburgh Health Care Systems, Critical Care Service, Pittsburgh, PA, USA; University of Pittsburgh, Departments of Critical Care Medicine and Emergency Medicine, Pittsburgh, PA, USA.
| | - Nilam J Soni
- South Texas Veterans Health Care System, Medicine Service, San Antonio, TX, USA; University of Texas Health San Antonio, Division of Hospital Medicine, San Antonio, TX, USA; University of Texas Health San Antonio, Division of Pulmonary Diseases & Critical Care Medicine, San Antonio, TX, USA.
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Kennedy SK, Ferre RM, Rood LK, Nti B, Ehrman RR, Brenner D, Rutz MA, Zahn GS, Herbert AG, Russell FM. Success of implementation of a systemwide point-of-care ultrasound privileging program for emergency medicine faculty. AEM Educ Train 2022; 6:e10744. [PMID: 35493291 PMCID: PMC9045579 DOI: 10.1002/aet2.10744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/10/2022] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Point-of-care ultrasound (POCUS) is widely used in the emergency department (ED). Not all practicing emergency physicians received POCUS training during residency, leaving a training gap that is reflected in POCUS privileging. The purpose of this study was to evaluate the success of meeting privileging criteria as well as associated factors, following implementation of a basic POCUS training and privileging program within a large emergency medicine department. METHODS We implemented a POCUS training and privileging program, based on national guidelines, for faculty physicians who worked at one of the following EDs staffed by the same emergency medicine department: a pediatric tertiary site, two tertiary academic sites, and seven community sites. POCUS examinations included aorta, cardiac, first-trimester obstetrics (OB), and extended focused assessment with sonography in trauma. Pediatric emergency medicine faculty were taught soft tissue and thoracic US instead of aorta and OB. Completion of the program required 16 h of didactics, ≥25 quality-assured US examinations by examination type, and passing a series of knowledge-based examinations. Descriptive statistics were calculated. Associations between physician characteristics and successfully becoming privileged in POCUS were modeled using Firth's logistic regression. RESULTS A total of 176 faculty physicians were eligible. A total of 145 (82.4%) achieved basic POCUS privileging during the study period. Different pathways were used including 86 (48.9%) practice-based, nine (5.1%) fellowship-based, and 82 (46.9%) residency-based. POCUS privileging was lower for those working in a community versus academic setting (odds ratio 0.3, 95% confidence interval 0.1-0.9). A greater number of scans completed prior to the privileging program was associated with greater success. CONCLUSIONS Implementation of a POCUS training and privileging program can be successful in a large emergency medicine department that staffs hospitals in a large-scale health care system composed of both academic and community sites. Faculty physicians with at least some prior exposure to POCUS were more successful.
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Affiliation(s)
- Sarah K. Kennedy
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Robinson M. Ferre
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Loren K. Rood
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Benjamin Nti
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Robert R. Ehrman
- Department of Emergency MedicineWayne State University School of MedicineDetroit Medical Center/Sinai‐Grace HospitalDetroitMichiganUSA
| | - Daniel Brenner
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Matt A. Rutz
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Greg S. Zahn
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Audrey G. Herbert
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Frances M. Russell
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
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Kennedy SK, Duncan T, Herbert AG, Rood LK, Rutz MA, Zahn GS, Welch JL, Russell FM. Teaching Seasoned Doctors New Technology: An Intervention to Reduce Barriers and Improve Comfort With Clinical Ultrasound. Cureus 2021; 13:e17248. [PMID: 34540474 PMCID: PMC8445865 DOI: 10.7759/cureus.17248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Although clinical ultrasound (CUS) is a core skill that is a requirement for emergency medicine (EM) residency graduation, only a fraction of EM practitioners who trained prior to this requirement are certified in CUS. The objective of the study was to implement a CUS workshop for practicing EM physicians, identify barriers to utilization, and assess comfort with the machine, obtaining and interpreting images, and incorporating CUS into clinical practice. Methods This was a prospective descriptive cohort study of EM physician faculty who participated in an interactive 5-hour CUS workshop intervention that introduced four core CUS modalities via didactics and hands-on scanning stations. Pre- and post-surveys were administered to identify barriers to utilization and assess perceived comfort with CUS using a 5-point Likert scale. Results were analyzed using Fisher's exact and paired t-tests. Results Thirty-five EM physicians participated with a 100% survey response rate. Only five of the physicians were ultrasound certified at the time of the workshop. On average, physicians were 16 years post-residency. Prior to the workshop, 29% had minimal ultrasound experience and 43% had not performed more than 50 ultrasounds. In the pre-course survey, every physician expressed at least one barrier to CUS utilization. Post-workshop, physicians felt significantly more comfortable using the ultrasound machine (p=0.0008), obtaining and interpreting images (p=0.0009 and p=0.0004), and incorporating CUS into clinical practice (p=0.002). Conclusion This workshop is an effective tool to expose practicing physicians to core concepts of CUS, improve their comfort level, and reduce barriers to ultrasound utilization.
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Affiliation(s)
- Sarah K Kennedy
- Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Taylor Duncan
- Emergency Department, St. Elizabeth Hospital, Edgewood, USA
| | - Audrey G Herbert
- Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Loren K Rood
- Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Matt A Rutz
- Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Gregory S Zahn
- Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Julie L Welch
- Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Frances M Russell
- Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA
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Melton M, Rupp JD, Blatt MI, Boyd JS, Barrett TW, Swarm M, Ward MJ. Description of the Use of Incentives and Penalties for Point-of-Care Ultrasound Documentation Compliance in an Academic Emergency Department. Cureus 2021; 13:e16199. [PMID: 34367802 PMCID: PMC8341210 DOI: 10.7759/cureus.16199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives Incomplete documentation and submission to the electronic health record of performed point-of-care ultrasound (POCUS) studies is problematic from a patient care, medicolegal, and billing standpoint. Positive and negative financial incentives may be used to motivate physicians to complete documentation workflow. The most efficacious route to improve POCUS workflow completion remains to be determined. Materials and methods A retrospective analysis of POCUS documentation in an academic emergency department during four distinct six-month blocks was performed. POCUS workflow completion was assessed without incentives (Baseline), with financial bonus (Incentive), interim period (Washout), and with a negative financial incentive (Penalty) to determine the effect of these incentives on workflow completion. Results There was an appreciable increase in the rate of POCUS studies documented between the "Baseline" (no incentive) and "Incentive" (small financial bonus) time periods. The improvement remained stable during the "Washout" (interim) period, and then increased further in the "Penalty" (negative financial incentive) period. This improvement was relatively diffuse among the providers studied. A similar pattern - improvements in the Incentive and Penalty periods with stability in the Washout - was also observed in the POCUS volume data (number of studies performed). Conclusions This study reveals a positive association between the implementation of both financial incentives and financial penalties, which increases in POCUS documentation among attending physicians at an academic emergency department.
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Affiliation(s)
- Myles Melton
- Emergency Medicine, Olympia Emergency Services, Olympia, USA
| | - Jordan D Rupp
- Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Marc I Blatt
- School of Medicine, Vanderbilt University, Nashville, USA
| | - Jeremy S Boyd
- Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Tyler W Barrett
- Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Matthew Swarm
- Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Michael J Ward
- Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
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Ienghong K, Tiamkao S, Bhudhisawasdi V, Gaysonsiri D, Apiratwarakul K. Point of Care Ultrasound in Geriatric Patients at the Emergency Department. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Point of care ultrasound (POCUS) plays an important role as a crucial tool for the diagnosis of various conditions in emergency and critical ill patients. However, POCUS examination in elderly populations has not been well studied.
AIM: This was a retrospective observational study of elderly patients at the Department of Emergency Medicine who had received POCUS examination at a tertiary university hospital, Thailand.
METHODS: The study was conducted throughout January 2020–December 2020. Patients’ characteristics and ultrasonography findings were recorded.
RESULTS: A total of 191 elderly patients were evaluated. Median patient age was 75.65 years; 56.02% of patients were female. Chief complaints where POCUS scans were applied were respiratory (36.65%) and cardiovascular system-related (21.99%). The most frequent procedures performed were cardiac, lung, and inferior vena cava examinations. Abnormal ultrasound findings were discovered in 133 patients (68.91%). The 66.17% of abnormal ultrasound findings were associated with final diagnosis. The admission rate of elderly patients (56.82%) was highest among patients with positive ultrasound findings associated with final diagnosis.
CONCLUSIONS: POCUS utilization in elderly patients was useful in aiding emergency physicians amid diagnosis of various diseases, especially life-threatening ones.
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Singh MR, Jackson JS, Newberry MA, Riopelle C, Tran VH, PoSaw LL. Barriers to point-of-care ultrasound utilization during cardiac arrest in the emergency department: a regional survey of emergency physicians. Am J Emerg Med 2021; 41:28-34. [PMID: 33383268 DOI: 10.1016/j.ajem.2020.12.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Though point-of-care ultrasound (POCUS) is recognized as a useful diagnostic and prognostic intervention during cardiac arrest (CA), critics advise caution. The purpose of this survey study was to determine the barriers to POCUS during CA in the Emergency Department (ED). METHODS Two survey instruments were distributed to emergency medicine (EM) attending and resident physicians at three academic centers in the South Florida. The surveys assessed demographics, experience, proficiency, attitudes and barriers. Descriptive and inferential statistics along with Item Response Theory Logistic Model and the Friedman Test with Wilcoxon Signed Rank tests were used to profile responses and rank barriers. RESULTS 206 EM physicians were invited to participate in the survey, and 187 (91%) responded. 59% of attending physicians and 47% of resident physicians reported that POCUS is performed in all their cases of CA. 5% of attending physicians and 0% of resident physicians reported never performing POCUS during CA. The top-ranked departmental barrier for attending physicians was "No structured curriculum to educate physicians on POCUS." The top-ranked personal barriers were "I do not feel comfortable with my POCUS skills" and "I do not have sufficient time to dedicate to learning POCUS." The top-ranked barriers for resident physicians were "Time to retrieve and operate the machine" and "Chaotic milieu." CONCLUSIONS While our study demonstrates that most attending and resident physicians utilize POCUS in CA, barriers to high-quality implementation exist. Top attending physician barriers relate to POCUS education, while the top resident physician barriers relate to logistics and the machines. Interventions to overcome these barriers might lead to optimization of POCUS performance during CA in the ED.
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Affiliation(s)
- Mallika R Singh
- University of Miami Miller School of Medicine, Miami, FL, United States of America.
| | - Jennifer S Jackson
- University of Miami Miller School of Medicine, Miami, FL, United States of America; Holy Cross Hospital, Ft. Lauderdale, FL, United States of America.
| | - Mark A Newberry
- Mt. Sinai Medical Center, Miami Beach, FL, United States of America.
| | - Cameron Riopelle
- University of Miami Miller School of Medicine, Miami, FL, United States of America; University of Miami Libraries, University of Miami.
| | - Vu Huy Tran
- Aventura Hospital & Medical Center, Aventura, FL, United States of America.
| | - Leila L PoSaw
- Jackson Memorial Hospital, Miami, FL, United States of America.
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Smalley CM, Fertel BS, Broderick E. Standardizing Point-of-Care Ultrasound Credentialing Across a Large Health Care System. Jt Comm J Qual Patient Saf 2020; 46:471-6. [PMID: 32430248 DOI: 10.1016/j.jcjq.2020.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is becoming prevalent in the daily practice of bedside clinicians. As large health care systems standardize practice patterns, an organized approach of credentialing physicians in POCUS is paramount for quality and patient safety. This study describes a systematic approach of credentialing a diverse group of community emergency physicians (EPs) across a large health care system. METHODS A multimodal POCUS credentialing initiative for EPs was implemented across 11 hospitals between January 1, 2017, and July 1, 2018, that included (1) standardization of POCUS credentialing for all hospitals in the system, (2) tiered POCUS credentialing (Basic and Intermediate) for manageable attainment of goals with a required POCUS course, (3) automatic privileges for EPs who completed residency or practice-based POCUS pathways prior to employment, and (4) implementation of a practice-based pathway for competency assessment for noncredentialed physicians. Key factors for implementation included executive administrative support, dedicated POCUS courses, equipment standardization, a robust electronic medical record capable of logging training scans, and competency assessment for attainment of privileges. RESULTS Through the initiative, 78/106 EPs achieved Intermediate credentialing, and 28/106 were without POCUS privileges. All 28 noncredentialed EPs completed the required Basic POCUS course. Almost half (13/28) completed the initiative and became credentialed. From 2016 to 2018, the number of EPs performing scans increased from 52 to 112, and the number of POCUS scans increased from 928 to 3,007. CONCLUSION A standardized POCUS credentialing initiative can be successfully implemented in large health care systems. Other specialties can use this initiative to implement POCUS into their daily practice.
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Schnittke N, Damewood S. Identifying and Overcoming Barriers to Resident Use of Point-of-Care Ultrasound. West J Emerg Med 2019; 20:918-925. [PMID: 31738719 PMCID: PMC6860390 DOI: 10.5811/westjem.2019.8.43967] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/05/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction Emergency medicine residency programs have rigorous point-of-care ultrasound (POCUS) curricula. However, this training does not always readily translate to routine use in clinical decision-making. This study sought to identify and overcome barriers that could prevent resident physicians from performing POCUS during clinical shifts. Methods This was a two-step process improvement study. First, a survey was deployed to all residents of a three-year academic residency program to identify barriers to clinical use of POCUS. This survey identified the perceived lack of a uniform documenting protocol as the most important barrier to performing POCUS on shift. Second, as an intervention to overcome this barrier, a streamlined documentation protocol was developed and presented to residents. The primary outcome was the number of patients who had POCUS used in medical decision-making one year before and after intervention. Secondary outcomes were the level of training of residents performing exams and whether faculty overseeing exams were trained through an ultrasound fellowship program. Results POCUS use by residents increased from 82 to 223 patients before and after the intervention, respectively. Per resident, this translates to an absolute increase from 2.2 (95% confidence intervall [CI], 1.4, 3) to 5.8 (95% CI, 4, 7.6) or 3.6 (95% CI, 1.8, 5.4) exams/resident over the study period. We observed no significant difference in the proportions of scans attributable to the resident level of training (χ2 = 0.5, p = 0.47). The proportion of exams by non-ultrasound fellowship trained faculty increased significantly more compared to fellowship trained faculty (χ2 = 19, p<0.0001); however, both ultrasound fellowship trained and non-ultrasound fellowship trained faculty increased the absolute number of exams performed. Conclusion A key perceived barrier to resident-performed POCUS is unfamiliarity with documenting ultrasounds for medical decision-making. Educating residents in person about a POCUS documentation protocol may help overcome this barrier. Incorporating resident input and motivation into POCUS incentivization may increase utilization. Future studies in optimizing POCUS on shift will need to focus on streamlining documentation, addressing time constraints, and faculty support for resident-performed POCUS.
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Affiliation(s)
- Nikolai Schnittke
- Oregon Health and Science University, Department of Emergency Medicine, Portland, Oregon
| | - Sara Damewood
- University of Wisconsin School of Medicine and Public Health, Department of Emergency Medicine, Madison, Wisconsin
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Boyd JS, LoPresti CM, Core M, Schott C, Mader MJ, Lucas BP, Haro EK, Finley EP, Restrepo MI, Kessler C, Colon-Molero A, Pugh J, Soni NJ. Current use and training needs of point-of-care ultrasound in emergency departments: A national survey of VA hospitals. Am J Emerg Med 2019; 37:1794-1797. [PMID: 30878406 DOI: 10.1016/j.ajem.2019.02.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jeremy S Boyd
- VA Tennessee Valley Healthcare System-Nashville, Department of Emergency Medicine, Nashville, TN, USA; Vanderbilt University, Department of Emergency Medicine, Nashville, TN, USA.
| | - Charles M LoPresti
- Louis Stokes Cleveland VA Medical Center, Medicine Service, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Department of Medicine, Cleveland, OH, USA.
| | - Megan Core
- Orlando VA Medical Center, Department of Emergency Medicine, Orlando, FL, USA; University of Central Florida College of Medicine, Department of Medicine, Orlando, FL, USA
| | - Christopher Schott
- VA Pittsburgh Health Care Systems, Critical Care Service, Pittsburgh, PA, USA; University of Pittsburgh, Departments of Critical Care Medicine and Emergency Medicine, Pittsburgh, PA, USA.
| | - Michael J Mader
- South Texas Veterans Health Care System, Medicine Service, San Antonio, TX, USA; UT Health San Antonio, Division of General & Hospital Medicine, San Antonio, TX, USA.
| | - Brian P Lucas
- White River Junction VA Medical Center, Medicine Service, White River, Junction, VT, USA; Dartmouth Geisel School of Medicine, Department of Medicine, Hanover, NH, USA.
| | - Elizabeth K Haro
- South Texas Veterans Health Care System, Medicine Service, San Antonio, TX, USA; UT Health San Antonio, Division of General & Hospital Medicine, San Antonio, TX, USA; (m) UT Health San Antonio, Division of Pulmonary & Critical Care Medicine, San Antonio, TX, USA.
| | - Erin P Finley
- South Texas Veterans Health Care System, Medicine Service, San Antonio, TX, USA; UT Health San Antonio, Division of General & Hospital Medicine, San Antonio, TX, USA.
| | - Marcos I Restrepo
- South Texas Veterans Health Care System, Medicine Service, San Antonio, TX, USA; (m) UT Health San Antonio, Division of Pulmonary & Critical Care Medicine, San Antonio, TX, USA.
| | - Chad Kessler
- Durham VA Health Care System, Primary Care Service, Durham, NC, USA; Duke University School of Medicine, Department of Medicine, Durham, NC, USA.
| | | | - Jacqueline Pugh
- South Texas Veterans Health Care System, Medicine Service, San Antonio, TX, USA; UT Health San Antonio, Division of General & Hospital Medicine, San Antonio, TX, USA.
| | - Nilam J Soni
- South Texas Veterans Health Care System, Medicine Service, San Antonio, TX, USA; UT Health San Antonio, Division of General & Hospital Medicine, San Antonio, TX, USA; (m) UT Health San Antonio, Division of Pulmonary & Critical Care Medicine, San Antonio, TX, USA.
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Alsaawi A, Alrajhi K, Alshehri A, Ababtain A, Alsolamy S. Ultrasonography for the diagnosis of patients with clinically suspected skin and soft tissue infections: a systematic review of the literature. Eur J Emerg Med 2017; 24:162-9. [PMID: 26485694 DOI: 10.1097/MEJ.0000000000000340] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In patients presenting with skin and soft tissue infections (SSTI), the use of ultrasound may lead to a more accurate distinction between cellulitis and abscess compared with clinical assessment alone. OBJECTIVES This systematic review aims to determine the diagnostic accuracy of ultrasound for detecting skin abscesses. In addition, it aims to assess the impact of using ultrasound on management decisions in patients with SSTI. METHODS We searched relevant electronic databases for primary studies including MEDLINE, EMBASE, and CINAHL. We searched conference proceedings, checked references of retrieved articles, and contacted field experts. Two reviewers assessed the quality of each full-text publication using a modified QUADAS-2 tool. RESULTS Five studies (n=710) fulfilled our inclusion criteria. Four studies compared the diagnostic accuracy of ultrasound with clinical examination alone (n=584). Most studies reported an improvement in diagnostic accuracy. The sensitivity of ultrasound ranged from 89 to 98% and the specificity ranged from 64 to 88%. However, the sensitivity of clinical assessment ranged from 75 to 90% and the specificity ranged from 55 to 83%; most of these results did not reach statistical significance. Sensitivity was further improved in cases of indeterminate clinical assessment. Two studies (n=176) examined the impact of ultrasound on management decisions. Use of ultrasound has led to significant and appropriate changes in management decisions in 16 to 39% of patients. CONCLUSION The use of ultrasound could potentially improve diagnostic accuracy and lead to improved management decisions in patients with SSTI, especially in cases of indeterminate clinical assessment. Most of our findings did not achieve statistical significance. Further research is required to confirm these findings.
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Javedani PP, Metzger GS, Oulton JR, Adhikari S. Use of Focused Assessment with Sonography in Trauma Examination Skills in the Evaluation of Non-trauma Patients. Cureus 2018; 10:e2076. [PMID: 29560289 PMCID: PMC5856419 DOI: 10.7759/cureus.2076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Study objectives Although the focused assessment with sonography in trauma (FAST) examination was initially developed for rapid evaluation of trauma patients, the basic skillset required to perform a FAST examination provides valuable information that may alter a non-trauma patient’s clinical course. The objective of this study was to determine the utility of the FAST examination in the emergency department management of non-trauma patients. Methods Cases in which the FAST examination was used to direct care in non-trauma patients were retrospectively reviewed. Following the completion of the patient's care, emergency physicians were asked to complete a questionnaire indicating how information from the FAST examination was utilized to direct care of their non-trauma patients. Results A total of 63 non-trauma cases with average age of 48 years (range 16-94 years) were enrolled. The FAST examination positively impacted care in 57/63 (90.5%) cases. In 18/63 (28.6%) cases, the patient’s ultimate disposition changed because of FAST examination findings. In 9/63 (14.3%) cases, paracentesis was avoided by obtaining a FAST examination, and in 8/63 cases (12.7%) paracentesis was performed due to FAST examination results. In 16/63 (25.4%) cases, anticipated imaging changed due to FAST examination findings and 4/63 (6.3%) cases did not receive the anticipated computed tomography (CT) scan. Conclusions Although initially developed for evaluation of trauma patients, the FAST examination can provide valuable information that can positively impact care in non-trauma patients. The FAST examination can provide information to determine appropriate patient disposition, obtain appropriate additional imaging, ensure timely consultation, and eliminate risk from unnecessary procedures.
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Hall MK, Hall J, Gross CP, Harish NJ, Liu R, Maroongroge S, Moore CL, Raio CC, Taylor RA. Use of Point-of-Care Ultrasound in the Emergency Department: Insights From the 2012 Medicare National Payment Data Set. J Ultrasound Med 2016; 35:2467-2474. [PMID: 27698180 DOI: 10.7863/ultra.16.01041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 02/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Point-of-care ultrasound is a valuable tool with potential to expedite diagnoses and improve patient outcomes in the emergency department. However, little is known about national patterns of adoption. This study examined nationwide point-of-care ultrasound reimbursement among emergency medicine (EM) practitioners and examined regional and practitioner level variations. METHODS Data from the 2012 Center for Medicare and Medicaid Services Fee-for-Service Provider Utilization and Payment Data include all practitioners who received more than 10 Medicare Part B fee-for-service reimbursements for any Healthcare Common Procedure Coding System code in 2012. Odds ratios (ORs) and descriptive statistics were calculated to assess relationships between ultrasound reimbursement and practice location, nearby presence of an EM residency, and time elapsed since practitioner graduation. RESULTS Of 52,928 unique EM practitioners, 391 (0.7%) received limited ultrasound reimbursements for a total of 16,389 scans in 2012. Urban counties had an OR of 5.4 (95% confidence interval, 3.8-7.8) for receiving point-of-care ultrasound reimbursements compared to rural counties. Counties with an EM residency had an OR of 84.7 (95% confidence interval, 42.6-178.8) for reimbursement compared to counties without. The OR for receiving reimbursement was independent of medical school graduation year (P = .83); however, recent graduates performed more scans (P = .02). CONCLUSIONS A small minority of EM practitioners received reimbursements for point-of-care ultrasound from Medicare beneficiaries. These practitioners were more likely to reside in urban and academic settings. Future efforts should assess the degree to which our findings reflect either low point-of-care ultrasound use or low rates of billing for ultrasound examinations that are performed.
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Affiliation(s)
- M Kennedy Hall
- Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington USA
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut USA
| | - Jane Hall
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale Cancer Center, and Yale University School of Medicine, Section of General Internal Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut USA
| | - Cary P Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale Cancer Center, and Yale University School of Medicine, Section of General Internal Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut USA
| | - Nir J Harish
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut USA
| | - Rachel Liu
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut USA
| | - Sean Maroongroge
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale Cancer Center, and Yale University School of Medicine, Section of General Internal Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut USA
| | - Christopher L Moore
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut USA
| | | | - R Andrew Taylor
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut USA
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Chen KC, Lin ACM, Chong CF, Wang TL. An overview of point-of-care ultrasound for soft tissue and musculoskeletal applications in the emergency department. J Intensive Care 2016; 4:55. [PMID: 27529031 PMCID: PMC4983782 DOI: 10.1186/s40560-016-0173-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/12/2016] [Indexed: 01/11/2023] Open
Abstract
Background The skin, soft tissue, and most parts of the musculoskeletal system are relatively superficial anatomical structures and ideal targets for ultrasound examination in the emergency departments. Soft tissue and musculoskeletal ultrasound applications are relatively underused compared to traditional emergency applications, such as trauma, abdominal aortic aneurysm, and chest and cardiovascular systems. Main text It is important to have knowledge about sonoanatomy and landmarks within the skin, soft tissue, and musculoskeletal systems. Portable machines equipped with high-resolution transducers are now available to fulfill this field of applications in many emergency departments. After needling practice, emergency physicians can not only diagnose and identify pathological findings but also provide interventional procedures and treatments. In this review, we will introduce point-of-care ultrasound (POCUS) applications regarding the soft tissue and musculoskeletal systems: soft tissue infections, joint effusions, foreign bodies, long bone fractures, muscle and tendon injuries, vascular occlusions, and procedures. Conclusions With POCUS, emergency physicians can visualize the structures beneath the skin and provide better and safer cares in the emergency departments. Electronic supplementary material The online version of this article (doi:10.1186/s40560-016-0173-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kuo-Chih Chen
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, No.95 Wen-Chang Road, Shih-Lin District, Taipei City, 111 Taiwan, Republic of China ; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Aming Chor-Ming Lin
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, No.95 Wen-Chang Road, Shih-Lin District, Taipei City, 111 Taiwan, Republic of China ; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chee-Fah Chong
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, No.95 Wen-Chang Road, Shih-Lin District, Taipei City, 111 Taiwan, Republic of China ; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Tzong-Luen Wang
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, No.95 Wen-Chang Road, Shih-Lin District, Taipei City, 111 Taiwan, Republic of China ; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
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Léger P, Fleet R, Maltais-Giguère J, Plant J, Piette É, Légaré F, Poitras J. A majority of rural emergency departments in the province of Quebec use point-of-care ultrasound: a cross-sectional survey. BMC Emerg Med 2015; 15:36. [PMID: 26655376 PMCID: PMC4676152 DOI: 10.1186/s12873-015-0063-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 12/07/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) can be used to provide rapid answers to specific and potentially life-threatening clinical questions, and to improve the safety of procedures. The rate of POCUS access and use in Canada is unclear. The objective of this study was to examine access to POCUS and potential barriers/facilitators to its use among rural physicians in Quebec. METHODS This descriptive cross-sectional study used an online survey. The 30-item questionnaire is an adapted and translated version of a questionnaire used in a prior survey conducted in rural Ontario, Canada. The questionnaire was pre-tested for clarity and relevance. The survey was sent to non-locum physicians working either full- or part-time in rural emergency departments (EDs) (n = 206). All EDs were located in rural and small towns and provided 24/7 medical coverage with acute care hospitalization beds. RESULTS In total, 108 surveys were completed (participation rate = 52.4%). Of the individuals who completed surveys, ninety-three percent were family physicians, and seven percent had Canadian College of Family Physicians - Emergency Medicine (CCFP-EM) certification. The median number of years of practice was seven. A bedside ultrasound device was available in 95% of rural EDs; 75.9% of physicians reported using POCUS on a regular basis. The most common indications for POCUS use were to rule out abdominal aortic aneurysm (70.4%) and to evaluate presence of free fluid in trauma and intrauterine pregnancy (60%). The most common reason (73%) for not using POCUS was limited access to POCUS training programs. Over 40% of POCUS users received training in POCUS during medical school or residency. Sixty-four percent received training from the Canadian Emergency Ultrasound Society, 13% received training from the Canadian Association of Emergency Physicians, and 23% were trained in another course. Finally, 95% of respondents reported that POCUS skills are essential for rural ED practice. CONCLUSIONS POCUS use in rural EDs in the province of Quebec appears to be relatively widespread. Access to training programs is a barrier to greater use.
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Affiliation(s)
- Pierre Léger
- Department of Family and Emergency Medicine, Université Laval, Quebec City, QC, Canada.
| | - Richard Fleet
- Department of Family and Emergency Medicine, Université Laval, Quebec City, QC, Canada. .,Research Centre, Emergency Medicine Laval University - CHAU Hôtel-Dieu de Lévis Hospital, 143 Wolfe Street, Lévis, QC, G6V 3Z1, Canada.
| | - Julie Maltais-Giguère
- Research Centre, Emergency Medicine Laval University - CHAU Hôtel-Dieu de Lévis Hospital, 143 Wolfe Street, Lévis, QC, G6V 3Z1, Canada.
| | - Jeff Plant
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. .,Department of Emergency Medicine, Penticton Regional Hospital, Penticton, BC, Canada.
| | - Éric Piette
- Department of Family and Emergency Medicine, Université de Montréal; Department of Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada.
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Knowledge Transfer and Health Technology Assessment of the CHUQ Research Centre (CRCHUQ, Unité de Recherche Évaluative, Université Laval; Implementation of Shared Decision Making in Primary Care, Quebec City, QC, Canada.
| | - Julien Poitras
- Department of Family and Emergency Medicine, Université Laval, Quebec City, QC, Canada. .,Research Centre, Emergency Medicine Laval University - CHAU Hôtel-Dieu de Lévis Hospital, 143 Wolfe Street, Lévis, QC, G6V 3Z1, Canada.
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Oviedo-García AA, Algaba-Montes M, Patricio-Bordomás M. [Ultrasound-guided techniques, also a very useful tool for nursing]. Semergen 2015; 42:503-504. [PMID: 26586584 DOI: 10.1016/j.semerg.2015.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/02/2015] [Indexed: 10/22/2022]
Affiliation(s)
- A A Oviedo-García
- Unidad de Gestión Clínica de Urgencias, Hospital Universitario de Valme, Sevilla, España.
| | - M Algaba-Montes
- Unidad de Gestión Clínica de Urgencias, Hospital Universitario de Valme, Sevilla, España
| | - M Patricio-Bordomás
- Unidad de Gestión Clínica de Urgencias, Hospital Universitario de Valme, Sevilla, España
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Herbst MK, Camargo CA, Perez A, Moore CL. Use of Point-of-Care Ultrasound in Connecticut Emergency Departments. J Emerg Med 2015; 48:191-196.e2. [DOI: 10.1016/j.jemermed.2014.09.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 08/03/2014] [Accepted: 09/02/2014] [Indexed: 11/29/2022]
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Ferre RM, Mercier M. Novel ultrasound guidance system for real-time central venous cannulation: safety and efficacy. West J Emerg Med 2014; 15:536-40. [PMID: 25035764 PMCID: PMC4100864 DOI: 10.5811/westjem.2014.1.16305] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 10/15/2013] [Accepted: 01/27/2014] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Real-time ultrasound guidance is considered to be the standard of care for central venous access for non-emergent central lines. However, adoption has been slow, in part because of the technical challenges and time required to become proficient. The AxoTrack(®) system (Soma Access Systems, Greenville, SC) is a novel ultrasound guidance system recently cleared for human use by the United States Food and Drug Administration (FDA). METHODS After FDA clearance, the AxoTrack(®) system was released to three hospitals in the United States. Physicians and nurse practitioners who work in the intensive care unit or emergency department and who place central venous catheters were trained to use the AxoTrack(®) system. De-identified data about central lines placed in living patients with the AxoTrack(®) system was prospectively gathered at each of the three hospitals for quality assurance purposes. After institutional review board approval, we consolidated the data for the first five months of use for retrospective review. RESULTS The AxoTrack(®) system was used by 22 different health care providers in 50 consecutive patients undergoing central venous cannulation (CVC) from September 2012 to February 2013. All patients had successful CVC with the guidance of the AxoTrack(®) system. All but one patient (98%) had successful cannulation on the first site attempted. There were no reported complications, including pneumothorax, hemothorax, arterial puncture or arterial cannulation. CONCLUSION The AxoTrack(®) system was a safe and effective means of CVC that was used by a variety of health care practitioners.
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Affiliation(s)
- Robinson M. Ferre
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee
| | - Mark Mercier
- Palmetto Health Baptist, Department of Emergency Medicine, Columbia, South Carolina
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Nagaraj G, Chu M, Dinh M. Emergency clinician performed ultrasound: availability, uses and credentialing in Australian emergency departments. Emerg Med Australas 2012; 22:296-300. [PMID: 20636359 DOI: 10.1111/j.1742-6723.2010.01306.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the current availability, uses and credentialing processes of emergency clinician performed ultrasound (EDUS) in Australian ED. METHODS Cross-sectional survey of Australian ED that are accredited for advanced training. RESULTS Ninety-four per cent of respondents (67/71, 95% confidence interval [CI] 86-98%) reported availability of EDUS. Availability was similar in both major referral and non-major referral ED. The most common uses for EDUS were focused abdominal sonography for trauma in 93% (62/67, 95% CI 83-97%), vascular access procedures in 90% (60/67, 95% CI 80-95%) and abdominal aortic aneurysm assessment in 88% of respondents (59/67, 95% CI 78-94%). Of the 67 departments with EDUS availability, 60% (40/67, 95% CI 48-71%) had a credentialing process. Of the major referral group 80% (20/25, 95% CI 61-91%) had a credentialing process compared with 52% (20/42, 95% CI 33-62%) in the non-major referral group. CONCLUSION Emergency department ultrasound is widely available in Australia. Only 60% of surveyed ED had a credentialing process in place for EDUS. This may be of concern given the current Australasian College for Emergency Medicine policy regarding EDUS.
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Affiliation(s)
- Guruprasad Nagaraj
- Emergency Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
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Backlund BH, Hopkins E, Kendall JL. Ultrasound guidance for central venous access by emergency physicians in colorado. West J Emerg Med 2012; 13:320-5. [PMID: 22942932 PMCID: PMC3421972 DOI: 10.5811/westjem.2011.11.6821] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 08/29/2011] [Accepted: 11/08/2011] [Indexed: 11/24/2022] Open
Abstract
Introduction To survey emergency physicians (EP) regarding the frequency of use of ultrasound guidance for placement of central venous catheters (UGCVC) and to assess their perceptions regarding the technique and barriers to its implementation. Methods A 25-question Web-based survey was e-mailed to all members of the Colorado chapter of the American College of Emergency Physicians with a listed e-mail address. A total of 3 reminders were sent to nonresponders. Results Responses were received from 116 out of 330 invitations. Ninety-seven percent (n = 112) of respondents indicated they have an ultrasound machine available in their emergency department, and 78% indicated they use UGCVC. Seventy-seven percent (n = 90) agreed with the statement, “Ultrasound guidance is the preferred method for central venous catheter placement in the emergency department.” However, 23% of respondents stated they have received no specific training in UGCVC. Twenty-six percent (n = 28) of respondents stated they felt “uncomfortable” or “very uncomfortable” with UGCVC, and 47% cite lack of training in UGCVC as a barrier to performing the technique. Conclusion Although the majority of surveyed EPs feel UGCVC is a valuable technique and do perform it, a significant percentage reported receiving no training in the procedure and also reported being uncomfortable performing it. Nearly half of those surveyed cited lack of training as a barrier to more widespread implementation of UGCVC. This suggests that there continues to be a need for education and training of EPs in UGCVC.
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Goodman TR, Scoutt LM, Brink JA. A survey of emergency physician-performed ultrasound: implications for academic radiology departments. J Am Coll Radiol 2012; 8:631-4. [PMID: 21889749 DOI: 10.1016/j.jacr.2011.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 03/17/2011] [Indexed: 12/20/2022]
Abstract
A survey of academic radiology departments shows that the prevalence of emergency room physician-performed ultrasound examinations is high and that providing a 24/7 attending radiology service leads to no significant reduction in physician activity.
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Affiliation(s)
- Thomas R Goodman
- Department of Diagnostic Radiology, Yale University, New Haven, Connecticut 06520, USA.
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Beaudoin FL, Merchant RC, Lincoln J, Gardiner F, Liebmann O, Cohn J. Bedside ultrasonography detects significant femoral vessel overlap: implications for central venous cannulation. CAN J EMERG MED 2011; 13:245-50. [PMID: 21722553 DOI: 10.2310/8000.2011.110482] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our goal was to gain a better understanding of the femoral vessel anatomy as it relates to central venous cannulation. The primary objective of this study was to use bedside ultrasonography to determine the amount of exposed femoral vein at three sites corresponding to surface anatomy of the landmark-based procedure. METHODS This cross-sectional study enrolled a random sample of 180 adult patients presenting to a large urban academic emergency department. Subjects underwent standardized ultrasonography to identify and measure the depth and diameter of the femoral vessels and amount of exposed femoral vein at the level of the inguinal ligament (0 cm) 2 cm and 4 cm below. Repeated measures analysis of variance was used to determine significant relationships between vessel measurements and distance from the inguinal ligament. RESULTS The median age was 44.5 (range 19-90) years; 101 patients were male. The mean (± SD) percentage of exposed vein at the inguinal ligament was 83% (± 21). This decreased significantly (p < 0.01) with increasing distance from the inguinal ligament: 65% (± 25) at 2 cm and 56% (± 30) at 4 cm. At every distance away from the inguinal ligament, there were some subjects with no vein exposed. CONCLUSION This study demonstrates significant overlap of the femoral vessels at sites where landmark-based femoral vein cannulation is often attempted. Our results suggest that ultrasound guidance would be beneficial as femoral vein cannulation may be difficult or impossible in certain individuals owing to anatomic variations.
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Affiliation(s)
- Francesca L Beaudoin
- Department ofEmergency Medicine, Rhode Island Hospital, 593 Eddy Street, Claverick 2, Providence, RI 02903, USA.
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Raja Rao MP, Prashanth P, Mukhaini M. A large left atrial myxoma detected in emergency department using bedside transthoracic echocardiography. J Emerg Trauma Shock 2011; 4:518-20. [PMID: 22090750 PMCID: PMC3214513 DOI: 10.4103/0974-2700.86651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 02/21/2011] [Indexed: 11/29/2022] Open
Abstract
We present a case of a 55-year-old woman with episodes of recurrent pulmonary edema that was diagnosed to have a large left atrial myxoma using bedside transthoracic echocardiography. This case illustrates the importance of a screening focused ultrasound examination of involved systems by emergency physicians in detecting causes for emergency clinical presentations.
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Adhikari S, Blaivas M, Lander L. Comparison of bedside ultrasound and panorex radiography in the diagnosis of a dental abscess in the ED. Am J Emerg Med 2011; 29:790-5. [DOI: 10.1016/j.ajem.2010.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 02/07/2010] [Accepted: 03/07/2010] [Indexed: 01/04/2023] Open
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Kerwin C, Tommaso L, Kulstad E. A brief training module improves recognition of echocardiographic wall-motion abnormalities by emergency medicine physicians. Emerg Med Int 2011; 2011:483242. [PMID: 22046540 DOI: 10.1155/2011/483242] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 05/09/2011] [Indexed: 11/29/2022] Open
Abstract
Objective. Wall-motion abnormality on echocardiogram is more sensitive in detecting cardiac ischemia than the electrocardiogram, but the use of bedside echocardiography by emergency physicians (EPs) for this purpose does not appear to be widespread, apparently due to limited data on proficiency of EPs for this task. We sought to determine the effect of a brief training module on the ability of EPs to recognize wall motion abnormalities on echocardiograms. Methods. We developed a brief training and testing module and presented it to EPs. After baseline testing of 15 echocardiograms, we presented the 30-minute training module, and administered a new test of 15 different echocardiograms. Physicians were asked to interpret the wall motion as normal or abnormal. Results. 35 EPs over two separate sessions showed significant improvement recognition of wall-motion abnormalities after the brief training module. Median score on the baseline test was 67%, interquartile range (IQR) 53% to 80%, while the median score on the posttraining test was 87%, IQR 80% to 87%, P < .001, independent of time in practice or prior training. Conclusion. With only brief training on how to recognize wall motion abnormalities on echocardiograms, EPs showed significant improvement in ability to identify wall motion abnormalities.
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Abstract
Abstract
Purpose
Although emergency ultrasound (EU) is gaining popularity, EU is performed in a minority of emergency departments (EDs). The perception may exist that EU is too time-consuming. This study sought to determine the duration of EUs performed for the primary indications by staff emergency physicians (EPs).
Methods
A prospective, time–motion study was conducted on a convenience sample of EUs at the Sudbury Regional Hospital ED from June to August 2006. All EPs had Canadian EU certification. A research assistant timed EUs. Primary EU indications in Canada are: cardiac arrest evaluation, rule-out pericardial effusion, rule-out intraperitoneal free fluid in trauma, rule-out abdominal aortic aneurysm, and rule-in intrauterine pregnancy. Descriptive statistics are reported.
Results
Eleven EPs performed 66 EUs for the primary indications on 51 patients. The mean EU duration was 137.8 s (range 11–465; CI 123.0–162.6). There was no difference in the duration of EUs performed by the two most experienced EPs (n = 37; duration = 129.4; CI = 96.4–162.4) compared to the other EPs (n = 29; duration = 148.4; CI = 110.6–186.2). Although subgroups were small, positive (n = 8; duration = 199.4; CI = 97.4–301.4), negative (n = 49; duration = 123.3; CI = 97.9–148.7), and indeterminate (n = 9; duration = 161.6; CI = 91.5–231.7) EUs did not differ in duration. There is some suggestion of differences in duration between types of EU, although again the subgroups were small: cardiac (n = 21; duration = 90.3; CI = 62.6–118.0), abdominal (n = 22; duration = 157.1; CI = 111.9–202.3), aneurysm (n = 15; duration = 170.1; CI = 117.5–222.7), transabdominal pelvic (n = 5; duration = 89.8; CI = 40.3–139.1), transvaginal (n = 3; duration = 246.0; CI = 30.6–461.4).
Conclusion
When performed by staff EPs with EU certification, mean EU duration for the primary indications was brief regardless of EP’s experience, EU type, or results.
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Adhikari S, Blaivas M. Utility of bedside sonography to distinguish soft tissue abnormalities from joint effusions in the emergency department. J Ultrasound Med 2010; 29:519-526. [PMID: 20375371 DOI: 10.7863/jum.2010.29.4.519] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the utility of bedside sonography to differentiate soft tissue abnormalities from joint effusions. METHODS We conducted a retrospective review of emergency department (ED) patients presenting with joint pain, erythema, and swelling who received bedside sonography. The ED sonographic examinations were performed by emergency physician sonologists who were not involved in clinical assessment and management of these patients. The treating physician's opinions regarding the probability of joint effusion and need for aspiration were documented in the sonography log before the sonographic examination was performed. The bedside sonograms of all patients included in this study were also reviewed for accuracy. Descriptive statistics were used to summarize the data. RESULTS A total of 54 patients (mean age +/- SD, 41 +/- 18.9 years) were identified over a 1-year period. The symptomatic joints in our study subjects were as follows: knee, 24 of 54 (44%); elbow, 21 of 54 (38%); ankle, 8 of 54 (15%); and metatarsophalangeal joint, 1 of 54 (2%). Twenty-two of 54 patients (40.7%; 95% confidence interval [CI], 27.6%-53.8%) were found to have joint effusions on sonography. Sonography altered management in 35 of 54 patients (65%; 95% CI, 52%-77.5%). Joint aspiration was planned in 39 of 54 cases (72.2%; 95% CI, 60.2%-84.1%) before sonography. After sonography, only 20 of these patients (37%; 95% CI, 24.1%-49.9%) underwent joint aspiration. There was a statistically significant difference in treatment plans after the addition of bedside sonographic results (P < .01). CONCLUSIONS Our study suggests that bedside sonography is useful in differentiating joint effusions from soft tissue abnormalities and directing appropriate therapy.
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Affiliation(s)
- Srikar Adhikari
- Department of Emergency Medicine, Northside Hospital Forsyth, 1200 Northside Forsyth Dr, Cumming, GA 30041-7659 USA
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