Model Point-of-Care Ultrasound Curriculum in an Intensive Care Unit Fellowship Program and Its Impact on Patient Management

Abstract

Objectives. This study was designed to assess the clinical applicability of a Point-of-Care (POC) ultrasound curriculum into an intensive care unit (ICU) fellowship program and its impact on patient care. Methods. A POC ultrasound curriculum for the surgical ICU (SICU) fellowship was designed and implemented in an urban, academic tertiary care center. It included 30 hours of didactics and hands-on training on models. Minimum requirement for each ICU fellow was to perform 25–50 exams on respective systems or organs for a total not less than 125 studies on ICU. The ICU fellows implemented the POC ultrasound curriculum into their daily practice in managing ICU patients, under supervision from ICU staff physicians, who were instructors in POC ultrasound. Impact on patient care including finding a new diagnosis or change in patient management was reviewed over a period of one academic year. Results. 873 POC ultrasound studies in 203 patients admitted to the surgical ICU were reviewed for analysis. All studies included were done through the POC ultrasound curriculum training. The most common exams performed were 379 lung/pleural exams, 239 focused echocardiography and hemodynamic exams, and 237 abdominal exams. New diagnosis was found in 65.52% of cases (95% CI 0.590, 0.720). Changes in patient management were found in 36.95% of cases (95% CI 0.303, 0.435). Conclusions. Implementation of POC ultrasound in the ICU with a structured fellowship curriculum was associated with an increase in new diagnosis in about 2/3 and change in management in over 1/3 of ICU patients studied.

Ultrasound in undergraduate medical education: a systematic and critical review

“…Among the studies reporting on the effects of training attending clinicians to perform POCUS, the application of POCUS was considered to contribute to changes in management in 16–37% of cases in different clinical contexts . Studies reported similar findings after training residents or fellows, with POCUS contributing to management changes in 16–40% of clinical applications . Only one study evaluated any impact on patient‐relevant outcomes of training medical students to perform POCUS, demonstrating improved safety of simulated central venous catheter placement using ultrasound …”

Sonographic Evaluation of Diaphragmatic Excursion and Thickness in Healthy Infants and Children

“…The idea of the “ultrasound stethoscope” is rapidly moving from the theoretical to reality, as had been described by Moore and Copel, 17 referring to the great advances in the use of sonography by the physician, not just the radiologist, for diagnosis and management of different diseases. In critical care, point‐of‐care sonography training programs involve the lungs, pleura, the abdomen, vascular access, basic echocardiography, and hemodynamic evaluations 18 . Sonography can be used for bedside assessment of diaphragmatic excursion and thickness, which can help clinicians and intensivists identify a normal moving diaphragm and verify diaphragmatic paresis and paralysis.…”

“…In critical care, point-of-care sonography training programs involve the lungs, pleura, the abdomen, vascular access, basic echocardiography, and hemodynamic evaluations. 18 Sonography can be used for bedside assessment of diaphragmatic excursion and thickness, which can help clinicians and intensivists identify a normal moving diaphragm and verify diaphragmatic paresis and paralysis. Sonographic assessment of diaphragmatic excursion and thickness is useful and better than other modalities such as fluoroscopy, magnetic resonance imaging, and transdiaphragmatic pressure measurement.…”

Curriculum for Fundamentals of Ultrasound in Clinical Practice

“…Exchange of ideas and expertise through conference calls, an in‐person meeting, and a common writing platform, with the guidance of AIUM Quality Initiatives Coordinator Kathi Minton, contributed to a consensus. This document reflects the product of that activity …”

“…This document reflects the product of that activity. [1][2][3][4][5][6][7][8][9][10][11][12] Fundamentals of Ultrasound Physics and Instrumentation [13][14][15][16][17][18][19][20][21][22][23][24] Ultrasound is a powerful tool for discerning the shapes, sizes, and textures of structures, their locations, and their spatial relationships. To optimize diagnostic images and operate safely, it is essential to understand fundamental principles of ultrasound.…”