Bøtker M T, Vang M L, Grøfte T, Kirkegaard H, Frederiksen C A, Sloth E
Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark.
Department of Anesthesiology and Intensive Care Medicine, Randers Regional Hospital, Randers, Denmark.
Acta Anaesthesiol Scand. 2017 Feb;61(2):156-165. doi: 10.1111/aas.12847.
Implementation of point-of-care ultrasonography (POCUS) of the heart and lungs requires image acquisition skills among providers. We aimed to determine the effect of POCUS implementation using a systematic education program on image acquisition skills and subsequent use and barriers in a department of anesthesiology.
Twenty-five anesthesiologists underwent a systematic education program in POCUS during the fall of 2012. A POCUS expert evaluated images from baseline and evaluation examinations performed on two healthy individuals as useful or not useful for clinical interpretation. In August 2016, anesthesiologists employed at the department answered a questionnaire regarding the use of POCUS and perceived barriers to its use.
The systematic education program increased the proportion of images useful for clinical interpretation from 0.70 (95% CI 0.65-0.75) to 0.98 (95% CI 0.95-0.99). This difference was significant when adjusted for prior cardiac ultrasonography courses, prior clinical cardiac ultrasonography experience, ultrasonography view, and ultrasound model (P < 0.001). After 3.5 years, 15/25 (60%) of perioperative medicine providers, 22/24 (92%) of intensive care providers, and 21/21 (100%) of pre-hospital care providers used POCUS either routinely, in selected patient groups, or sporadically.
Implementation of POCUS by a systematic education program increased image acquisition skills across anesthesiologists employed at the department. POCUS was used in the intensive care setting, the pre-hospital setting, and to a lesser extent in the perioperative setting. Educational strategies for obtaining images under difficult conditions, practical equipment and evidence for effect on patient outcomes are required for full implementation of POCUS.
实施心脏和肺部的床旁超声检查（POCUS）需要医护人员具备图像采集技能。我们旨在确定采用系统教育计划实施POCUS对麻醉科医护人员图像采集技能、后续使用情况及障碍的影响。
2012年秋季，25名麻醉医生接受了POCUS系统教育计划。一名POCUS专家评估了对两名健康个体进行的基线检查和评估检查所获图像，判断其对临床解读是否有用。2016年8月，该科室的麻醉医生回答了一份关于POCUS使用情况及使用障碍的问卷。
系统教育计划使对临床解读有用的图像比例从0.70（95%可信区间0.65 - 0.75）提高到0.98（95%可信区间0.95 - 0.99）。在对先前心脏超声课程、先前临床心脏超声检查经验、超声检查视图和超声型号进行校正后，这一差异具有统计学意义（P < 0.001）。3.5年后，15/25（60%）的围手术期医疗人员、22/24（92%）的重症监护人员和21/21（100%）的院前护理人员常规、在特定患者群体中或偶尔使用POCUS。
通过系统教育计划实施POCUS提高了该科室麻醉医生的图像采集技能。POCUS在重症监护环境、院前环境中得到应用，在围手术期环境中的应用较少。要全面实施POCUS，需要制定在困难条件下获取图像的教育策略、实用设备以及对患者预后影响的证据。
