Browsing by Author "Brenner, Daniel"

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    A Novel Approach to Point-of-Care Ultrasound (POCUS) Education: One-page Documents with Embedded E-Curriculum
    (2025-04-25) Markus, Nathan; Brenner, Daniel; Duncan, Francesca; Sanjuan, Adriano; Osborn, Eric; Carlos, Grahm; Jackson; Rishi, Muhammed; Jackson, Edwin
    Background: Point-of-care ultrasound (POCUS) has proven to be a valuable adjunct to the modern physical exam. The gold-standard approach of 1-on-1 learning image acquisition from sonographers and interpretation from clinician-experts is resource intensive, highlighting a need for alternative methods of teaching POCUS. Methods: This educational project utilized iterative development with the help of established POCUS educators and learner feedback in the form of surveys. Pre- and post- 30-day rotation surveys were administered and collected in Microsoft Forms. The survey questions comprised several categories including interest in learning POCUS, technical skill/image acquisition, and confidence in image interpretation. Learners were asked to rate their confidence in image acquisition and interpretation on a 5-level scale from “no skill” to “expert skill” as defined in the figures. Results: Preliminary survey data (n = 14) have been collected. Detailed results available in figures 2 and 3. In summary, 60% of learners were likely/very likely to use POCUS in clinical practice and 40% of learners were unlikely/very unlikely. Pre-intervention, 10% of learners rated their proficiency at image acquisition/probe placement at “no skill”, which decreased to 0% post-intervention. Sufficient skill in image acquisition increased from 20% pre-intervention to 50% post-intervention. Regarding image interpretation, 30% of learners rated skill in identifying anatomy as “no skill” or “little skill”. After the intervention, these groups decreased to 0%. Lastly, all participants felt that they were more confident in identifying cardiac anatomy after engaging with this project. All participants also reported that they would continue to use this resource this to learn POCUS. Conclusions: Learners perceive both value and effectiveness of this educational module. More work must be done to improve objectivity of results including engagement data, competency-based assessments, and randomization against the current standard education model.
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    Emergency Medicine Faculty Utilization of Point-of-Care Ultrasound in the Clinical Setting
    (Springer Nature, 2025-02-11) Russell, Frances M.; Ferre, Robinson M.; Kennedy, Sarah K.; Nti, Benjamin; Frey, Drew; Brenner, Daniel; Emergency Medicine, School of Medicine
    Introduction: Point-of-care ultrasound (POCUS) curricula for emergency medicine residents and faculty are guided by emergency medicine societal ultrasound guidelines. These guidelines lack clinical data to support them and are mainly based on expert consensus recommendations. Data are needed to address critical gaps in the literature to identify which POCUS studies are most commonly utilized in the clinical setting to help guide guideline recommendations and POCUS curricular design. The primary aim of this study was to determine the most utilized POCUS modalities in the emergency department clinical setting. The findings of this study may be used to guide the curricular design of future POCUS trainings. Methods: This was a retrospective study evaluating all clinically indicated and billed POCUS studies performed and interpreted by faculty in the emergency department setting across 10 emergency departments over a three-year period in Indianapolis, Indina, USA. The number of exams and modalities were extracted from the POCUS workflow solution. The frequency and percentage of exams were calculated. Results: A total of 5,324 POCUS examinations were performed. Cardiac, obstetric, soft tissue, and focused assessment with sonography in trauma (FAST) POCUS were the most billed modalities across all adult emergency departments regardless of academic or community setting. Although fewer data were available from the pediatric setting, we found that cardiac, soft tissue, FAST, and lung POCUS exams were the most utilized. Conclusion: These data from a single healthcare system would suggest that emergency physician POCUS curricula should focus on cardiac, obstetric, soft tissue, FAST, and lung exams. More data are needed from the pediatric setting to determine which scans are most utilized.
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    Leveraging Advanced Cardiac POCUS in the Diagnosis of Infective Endocarditis with Negative Conventional Imaging: A Case Report
    (2025-04) Sanjuan, Adriano; Andrade, Heather; Bundy, Alyson; Clapham, Philip; Markus, Nathan; Brenner, Daniel; Hariri, Irina; Jackson, Edwin
    Introduction. Infective endocarditis (IE) is a life-threatening condition that includes bacteremia and echocardiographic findings. However, many cases yield inconclusive results with transthoracic (TTE) or transesophageal echocardiography (TEE), creating diagnostic challenges. This report highlights the role of advanced cardiac point-of-care ultrasound (POCUS) in addressing these limitations, using daily POCUS exams to address these limitations. Case report. A 68-year-old male with methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia and recurrent fevers underwent multiple conventional TTEs and a TEE, that failed to detect valvular vegetations. Advanced cardiac POCUS, including parasternal long-axis (PLAX), parasternal short-axis (PSAX), right ventricular (RV) inflow/outflow, and apical four-chamber views, was performed daily at the bedside. The PLAX view enabled visualization of new onset of aortic regurgitation, and Color Doppler imaging was applied to assess the severity of the valve disfunction. A vegetation in the aortic valve was identified, later confirmed by a consultative TTE and TEE, leading to a change in management. Discussion. This case highlights the utility of advanced cardiac POCUS in diagnosing IE when conventional imaging is inconclusive. Advanced cardiac POCUS offers immediate, bedside diagnostic insights, making it a valuable tool for critically ill patients. Compared to basic cardiac POCUS, the advanced cardiac POCUS includes the RV inflow/outflow (that can be achieved through tilting or fanning of the probe), and use of color Doppler. A study by Hellmann et al. demonstrated that medical residents could achieve significant proficiency with color Doppler, with minimal formal training, aligning with our experience. Despite limitations such as operator dependency and patient characteristics, the integration of advanced cardiac POCUS into diagnostic workflows has the potential to improve diagnostic accuracy and outcomes. Additionally, the case emphasizes the need for advanced cardiac POCUS education among trainees, expanding their ability to address complex clinical scenarios.
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    Success of implementation of a systemwide point-of-care ultrasound privileging program for emergency medicine faculty
    (Wiley, 2022-04-01) Kennedy, Sarah K.; Ferre, Robinson M.; Rood, Loren K.; Nti, Benjamin; Ehrman, Robert R.; Brenner, Daniel; Rutz, Matt A.; Zahn, Greg S.; Herbert, Audrey G.; Russell, Frances M.; Emergency Medicine, School of Medicine
    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.