Amini Richard, Wyman Michael T, Hernandez Nicholas C, Guisto John A, Adhikari Srikar
Department of Emergency Medicine, University of Arizona, Tucson, Arizona, USA.
University of Arizona College of Medicine, Tucson, Arizona, USA.
J Ultrasound Med. 2017 May;36(5):913-921. doi: 10.7863/ultra.16.05064. Epub 2017 Feb 2.
Despite the increased educational exposure to point-of-care ultrasound (US) at all levels of medical training, there are utilization gaps between academic and nonacademic emergency department (ED) settings. The purpose of this study was to assess the current practices and potential barriers to the use of point-of-care US in nonacademic EDs throughout the state of Arizona.
We conducted a cross-sectional study. An online questionnaire was electronically sent to all nonacademic EDs in Arizona. The survey consisted of questions regarding demographics, current practice patterns, policies, interdepartmental agreements, and perceptions regarding the use of point-of-care US.
Seventy nonacademic EDs were identified for inclusion in our study, and 58 EDs completed the survey, which represented an 83% response rate. Seventy-eight percent (95% confidence interval [CI], 67%-89%) perform or interpret point-of-care US examinations for patient care. The 3 most common applications of point-of-care US reported by respondents were focused assessment with sonography for trauma, cardiac US examinations, and line placement, and 36% (95% CI, 22%-50%) bill for point-of-care US examinations. At 75% (95% CI, 62%-88%) of EDs, no one is specifically responsible for reviewing point-of-care US examinations for quality assurance, and at 50% (95% CI, 35%-65%), no mechanism exists to archive images. Eighty-three percent (95% CI, 72%-94%) of EDs think that their groups will benefit from the American College of Emergency Physicians Clinical Ultrasound Accreditation Program.
Ultrasound equipment is available in nearly all nonacademic EDs in Arizona. However, it appears that most providers lack US training, credentialing, quality assurance, and reimbursement mechanisms.
尽管在各级医学培训中，即时超声（POCUS）的教育普及程度有所提高，但学术性和非学术性急诊科（ED）在其使用方面仍存在差距。本研究的目的是评估亚利桑那州非学术性急诊科使用即时超声的当前实践情况及潜在障碍。
我们开展了一项横断面研究。通过电子邮件向亚利桑那州所有非学术性急诊科发送了一份在线问卷。该调查包括有关人口统计学、当前实践模式、政策、部门间协议以及对即时超声使用的看法等问题。
确定了70家非学术性急诊科纳入我们的研究，58家急诊科完成了调查，回复率为83%。78%（95%置信区间[CI]，67%-89%）的急诊科为患者护理进行或解读即时超声检查。受访者报告的即时超声3种最常见应用为创伤超声重点评估、心脏超声检查和血管置管，36%（95%CI，22%-50%）的急诊科对即时超声检查收费。在75%（95%CI，62%-88%）的急诊科，没有人专门负责审查即时超声检查以确保质量，在50%（95%CI，35%-65%）的急诊科，不存在存档图像的机制。83%（95%CI，72%-94%）的急诊科认为其团队将从美国急诊医师学会临床超声认证项目中受益。
亚利桑那州几乎所有非学术性急诊科都配备了超声设备。然而，似乎大多数医疗服务提供者缺乏超声培训、资质认证、质量保证和报销机制。
