Pediatric Residents' Perceptions of a Point-of-Care Ultrasound Collaboration With Emergency Medicine

Background Pediatric residencies expanding their point-of-care ultrasound (POCUS) education face barriers, including a lack of established curriculum and qualified educators. Prior studies report partnerships between pediatrics and pediatric emergency medicine (PEM); however, many non-PEM emergency medicine (EM) physicians with POCUS fellowship training also have experience with pediatric POCUS and represent an alternate educational partner. Objectives To improve pediatric residents' POCUS skills through collaborative education with EM and evaluate perceptions of the teaching format and instructors. Methods First through third-year pediatric residents attended a half-day didactic and hands-on session about renal, lung, and musculoskeletal (MSK) POCUS. These educational sessions were led by EM faculty with POCUS fellowship training and assisted by EM residents. Post-session surveys were administered to pediatric residents to assess prior POCUS experience, changes in confidence in acquiring and interpreting renal, lung, and MSK POCUS images, and opinions about the educational format. Statistical analyses of the post-session survey data were performed using SPSS. Results Thirty-nine pediatric residents attended the session and completed the survey of 45 total residents in the program (86.7%), with 89.7% completing 10 or fewer POCUS studies. Residents' comfort level with performing lung POCUS increased from 5.1% to 82.1% (p < .001), renal POCUS from 10.3% to 76.9% (p < .001), and MSK POCUS from 7.7% to 84.6% (p < .001). 87.2% rated the educational format as effective, and 94.9% (37/39) rated emergency medicine faculty as 'very effective' in providing ultrasound education relevant to the practice of pediatrics. Conclusion Pediatric resident POCUS education taught by EM faculty with POCUS fellowship training was well-received by pediatric residents and significantly improved confidence in acquiring and interpreting POCUS.

Does Patient Weight, Age, or Gender Correlate With the Ability to Visualize the Distal Aorta on Bedside Aortic Ultrasounds in the Emergency Department?

INTRODUCTION

Abdominal aortic aneurysms (AAA) have a varied presentation, which often makes the diagnosis difficult. The most common location for an AAA is in the infra-renal or distal aorta, which can be difficult to visualize using bedside ultrasound.  Objective: This study was designed to identify if a patient's weight, gender, or age influenced our ability to visualize the distal aorta on bedside abdominal aortic ultrasound scans.  Methods: All aortic scans completed in the Emergency Department (ED) from September 2010 to September 2013 were retrospectively evaluated. Patients 21 years and older were included. Scans missing age, gender, or self-reported weight were excluded.  Results: 500 aortic scans were included. The distal aorta was visualized in 393 scans (78.6%). The mid aorta was visualized in 417 scans (83.4%). The proximal aorta was visualized in 454 scans (90.8%). For the distal aorta, the average weight for visualized versus not visualized was 75.7 kg versus 79.7 kg. For the proximal aorta, the average weight for visualized versus not visualized was 75.8 kg versus 84.0 kg. Weight significantly predicted the ability to visualize the proximal aorta (unadjusted p=0.0098, adjusted p=0.0095) and marginally predicted the ability to visualize the distal aorta (unadjusted p=0.071, adjusted p=0.019). Neither age (unadjusted p=0.13, adjusted p=0.052) nor gender (unadjusted p=0.74, adjusted p=0.40) was significantly associated with visualization.

CONCLUSION

There is no clinically significant difference in the ability to visualize a patient's distal aorta with bedside ultrasound based on a patient's body weight, gender, or age.

Impact of Bedside Ultrasound on Emergency Department Length of Stay and Admission in Patients With a Suspected Peritonsillar Abscess

Introduction Patients presenting to the Emergency Department (ED) with a suspected peritonsillar abscess (PTA) often pose a diagnostic dilemma, as clinical impression is often unreliable and traditional diagnostic methods have multiple downsides. Bedside ultrasonography has been cited as a modality to improve the diagnosis and management of PTA. We aimed to determine the impact bedside ultrasound (US) could have in suspected PTA on ED length of stay (LOS) and hospital admission rates. Methods We performed a retrospective chart review on patients who presented to the ED with suspected ''peritonsillar abscess''. Results From a sample of 58 charts, seven had documented bedside US performed. The average ED length of stay for these seven cases was 160 minutes (range: 52 to 270 minutes). The ED length of stay for all other cases utilizing other diagnostic methods during the same time period was 293 minutes (range: 34 to 780 minutes). None of the patients who were diagnosed with US were admitted to the hospital, whereas 36.4% of patients where US was not used were admitted. Conclusion The use of bedside US in seven cases of suspected PTA had reduced LOS in the ED and none required hospital admission.

Approach to Formalized Ultrasound Credentialing in a Community Hospital Health System with both Academic and Non-Academic Clinical Settings

INTRODUCTION

In the US, ultrasound in Emergency Medicine (EM) is widely considered the standard of care in clinical practice amongst most Emergency Department providers. At the authors' institution and affiliates, there were a variety of health care providers utilizing ultrasound for clinical practice, and their skill levels varied, dependent on training and exposure. As an attempt to standardize credentialing practice and determine need for additional training thresholds, the authors endeavored to perform a skills assessment utilizing both written and clinical based practical assessments.

METHODS

A 7 point questionnaire was administered to a convenience sample of providers requesting formal training information, number of ultrasounds performed, and self-assessed competency. A 10 point written assessment with ultrasound knowledge and clinical application questions was also administered. A subsequent clinical assessment on live humans and models was then performed with multiple stations assessing 15 different instrumentation skills and technique, as well as image interpretation and evaluation.

RESULTS

A total of 23 attending EM board-certified physicians, and four advanced practice providers (PA and NP) took the credentialing assessments scoring an average of 7.3 out of 10 (SD 0.83) for the written assessment. Twenty (71%) of the 28 tested passed the clinical evaluation on their initial attempt. Five (17%) passed on a first remediation. Three (10%) required more than one initial revision attempt. All those who did remediate were able to complete the revision with a passing score.

CONCLUSIONS

Overall, the testing was considered a successful process. This program appears to have offered a level of standardization that was appealing to the credentialing body at our institution. We were able to assess to a level of competence considered standard of care by national credentialing bodies.