Operating bedside cardiac ultrasound program in emergency medicine residency: A retrospective observation study from the perspective of performance improvement

Abstract

Background Point-of-care ultrasound is one of useful diagnostic tools in emergency medicine practice and considerably depends on physician’s performance. This study was performed to evaluate performance improvements and favorable attitudes through structured cardiac ultrasound program for emergency medicine residents. Methods Retrospective observational study using the point-of-care ultrasound (PoCUS) database in one tertiary academic-teaching hospital emergency department has been conducted. Cardiac ultrasound education and rotation program has been implemented in emergency medicine residency program. Structured evaluation sheet for cardiac ultrasound and questionnaire toward PoCUS have been developed. An early-phase and a late-phase case were selected randomly for each participant. Two emergency medicine specialists with expertise in PoCUS evaluated saved images independently. We used a paired t-test to compare the performance score of each phase and the results of the questionnaire. Multivariable linear regression analysis was conducted to evaluate the association between the characteristics of participants and performance improvements. Results During the study period, a total of 1,652 bedside cardiac ultrasounds were administered. Forty-six examinations conducted by 23 emergency medicine residents were randomly selected for analysis. The performance score increased from 39.5 to 56.1 according to expert A and 45.3 to 62.9 according to expert B (p-value <0.01 for both). The average questionnaire score, which was analyzed for 17 participants, showed improvement from 18.9 to 20.7 (p-value <0.01). In multivariable linear regression analysis, younger age, higher early-phase score and higher confidence had a negative association with a greater improvement of performance, while the number of examinations had a positive association. Conclusions Bedside cardiac ultrasound performance and attitudes toward PoCUS have been improved through structured residency program.

Development of Score System Based on Point-of-Care Ultrasound to Predict Vasopressor Requirement for Emergency Patients With Cardiopulmonary Symptoms

“…If a patient complains of cardiopulmonary symptoms, such as chest pain, dyspnea, palpitation, or syncope, POCUS can be performed by a physician to assess heart function or intravascular volume status immediately. POCUS is usually provided by either bedside-ultrasound program in the studying institute (21) or primary physician assigned for the patient. Point-of-care blood tests, usually comprising blood gas analysis and lactate measurement, can be conducted to assess the acid-base status as early as possible.…”

“…This retrospective study aimed to develop a new scoring system based on the POCUS database of a tertiary academic teaching hospital. The study institution (21) or primary physician assigned for the patient. Pointof-care blood tests, usually comprising blood gas analysis and lactate measurement, can be conducted to assess the acid-base status as early as possible.…”