Browsing by Subject "Point-of-care ultrasound (POCUS)"

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    External validation of the ultrasound competency assessment tool
    (Wiley, 2023-06-22) Russell, Frances M.; Herbert, Audrey; Kennedy, Sarah; Nti, Benjamin; Powell, Mollie; Davis, Jean; Ferre, Robinson; Emergency Medicine, School of Medicine
    Objective: Point-of-care ultrasound (POCUS) is a core component of emergency medicine (EM) residency training. No standardized competency-based tool has gained widespread acceptance. The ultrasound competency assessment tool (UCAT) was recently derived and validated. We sought to externally validate the UCAT in a 3-year EM residency program. Methods: This was a convenience sample of PGY-1 to -3 residents. Utilizing the UCAT and an entrustment scale, as described in the original study, six different evaluators split into two groups graded residents in a simulated scenario involving a patient with blunt trauma and hypotension. Residents were asked to perform and interpret a focused assessment with sonography in trauma (FAST) examination and apply the findings to the simulated scenario. Demographics, prior POCUS experience, and self-assessed competency were collected. Each resident was evaluated simultaneously by three different evaluators with advanced ultrasound training utilizing the UCAT and entrustment scales. Intraclass correlation coefficient (ICC) between evaluators was calculated for each assessment domain; analysis of variance was used to compare UCAT performance and PGY level and prior POCUS experience. Results: Thirty-two residents (14 PGY-1, nine PGY-2, and nine PGY-3) completed the study. Overall, ICC was 0.9 for preparation, 0.57 for image acquisition, 0.3 for image optimization, and 0.46 for clinical integration. There was moderate correlation between number of FAST examinations performed and entrustment and UCAT composite scores. There was poor correlation between self-reported confidence and entrustment and UCAT composite scores. Conclusions: We had mixed results in our attempt to externally validate the UCAT with poor correlation between faculty and moderate to good correlation with faculty to diagnostic sonographer. More work is needed to validate the UCAT before adoption.
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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.