Effectiveness of a multicenter training programme to teach point‐of‐care vascular ultrasound for the detection of peripheral arterial disease in people with diabetes

Abstract

BackgroundThe primary aim of this study was to evaluate the effectiveness of a training programme to teach a focused bedside ultrasound scan (PAD-scan; Podiatry Ankle Duplex Scan) for the detection of arterial disease in people with diabetes.MethodsFive podiatrists and one diabetologist across two hospitals were enrolled in a structured training programme consisting of a training course (1-day), supervised scanning (5-weeks), independent scanning (3-weeks) and a final evaluation of performance (1-day).Time, technical skills (Duplex Ultrasound Objective Structured Assessment of Technical Skills tool (DUOSATS); minimum score = 6, maximum score = 26) and accuracy (level of agreement with vascular scientist PAD-scan assessment) were assessed for every supervised scan and again for the final evaluation of performance.ResultsA total of 90 PAD-scans in 65 patients were performed during the supervised phase. Participants demonstrated significant improvements in median time (19 min(IQR 13.9–25.5) vs 9.3 min (IQR 7.3–10.5); p = 0.028) and DUOSATS scores (17.5 (IQR 16.8–21) vs 25 (IQR 24–25.3); p = 0.027). At the final evaluation, participants completed scans in 5.4 min (IQR 5.3–5.9), achieved full DUOSAT scores and perfect agreement with the vascular scientist.ConclusionA structured training programme, integrated into diabetic foot clinics, was effective in teaching the PAD-scanElectronic supplementary materialThe online version of this article (10.1186/s13047-018-0283-0) contains supplementary material, which is available to authorized users.

Diagnostic Accuracy of Point-of-care Tests Used to Detect Arterial Disease in Diabetes

“…The implementation of PAD-scan in clinical practice necessitates training of front-line staff which can be effectively integrated into clinics. 10 An alternative model of care could involve PAD detection clinics being delivered by vascular scientists who would not require additional training.…”

“…We have previously demonstrated that a focused DUS scan of the anterior and posterior tibial arteries at the ankle (PAD-scan; Podiatry Ankle Duplex scan; Figure S1-2, http://links.lww.com/SLA/ C885) can be readily learnt and accurately performed by frontline staff. 10,11 The primary aim of this present study is to determine the ability of the PAD-scan and other commonly performed index tests [handheld Doppler (audible and visual), ABPI, TBPI, TcPO2, and pulse palpation] to discriminate between the presence and absence of PAD in diabetes, as compared with the reference test of full lower limb arterial DUS.…”

Cost-effectiveness of Diagnostic Tools to Establish the Presence of Peripheral Arterial Disease in People With Diabetes

“…15,23,[25][26][27][28] For PAD-scan, in addition to equipment costs, costs of training were calculated based on a previous study. 11 This included additional costs related to ongoing training during the model period.…”

Arterial spectral waveform analysis in the prediction of diabetic foot ulcer healing

“…Data were collected as part of a previously published study exploring the effectiveness of a multi-centre training programme to teach focused DUS examination of the anterior and posterior tibial arteries at the level of the ankle for the detection of PAD in diabetes. 4 As part of the training programme, consecutive patients presenting to diabetic foot clinics at a teaching hospital in London and a district general hospital in London were invited to take part in the study and provided informed consent. A fully qualified vascular scientist performed the scan on each patient.…”