Education, Teaching, and Quality Improvement |

Brief Training Can Improve Nonphysician Comfort in Obtaining Remotely-Guided Ultrasound Images FREE TO VIEW

Andrea Levine, MD; Jessica Buchner; Avelino Verceles; Marc Zubrow; Michael McCurdy
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University of Maryland School of Medicine, Division of Pulmonary and Critical Care, Baltimore, MD

Chest. 2014;146(4_MeetingAbstracts):487A. doi:10.1378/chest.1988611
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SESSION TITLE: Education and Teaching in Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Telemedicine increasingly provides nocturnal critical care support in ICUs, and much of this care is provided in a bedside physician’s absence. Ultrasound is a valuable point-of-care diagnostic tool for the critically ill, and ultrasound images acquired directly with the ultrasound are of comparable quality to those visualized via telemedicine technology (Levine et al., High Quality Ultrasound Images Can Be Acquired By Non-Physicians Instructed By Tele-Intensivists, ATS International Conference, San Diego, California 2014). Non-physicians, infrequently formally trained in ultrasound, are the primary bedside providers in the ICU at night. We conducted an educational feasibility pilot to assess non-physician satisfaction and comfort performing bedside tele-ultrasound before and after receiving a brief training session.

METHODS: Non-physicians (i.e., nurses, nursing students, respiratory therapists) volunteered for this educational pilot. Training consisted of a 20-minute slide presentation covering basic sonography, “knobology,” and image acquisition of the internal jugular, lung apices and bases, heart (subxiphoid view), and bladder. A remotely located physician provided non-physicians real-time guidance via a Philips VISICU two-way camera to acquire suitable ultrasound images using a SonoSite S-ICU™. Each non-physician completed a survey, which included demographic information and five-point Likert scales to assess training experience and comfort using ultrasound before and after training.

RESULTS: Eleven non-physician "ultrasonographers" participated in the educational pilot. Twenty-seven percent (3/11) had prior ultrasound experience (mean 2.3 years). All participants agreed (defined as “agree” or “strongly agree”) that the training session prepared them for image acquisition and that the training and experience acquiring images were positive. The number of ultrasonographers that were comfortable with ultrasound varied significantly (p<0.001) before (2/11 [18%]; mean Likert score 2.6) and after (11/11 [100%]; mean Likert score 4.8) study participation.

CONCLUSIONS: After a brief training session and minimal real-time instruction, non-physicians can comfortably perform bedside ultrasound guided by a tele-intensivist.

CLINICAL IMPLICATIONS: With proper training and real-time guidance, non-physicians could comfortably utilize basic bedside ultrasound skills to facilitate faster diagnoses and reduce ICU costs, while simultaneously increasing provider satisfaction.

DISCLOSURE: The following authors have nothing to disclose: Andrea Levine, Jessica Buchner, Avelino Verceles, Marc Zubrow, Michael McCurdy

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