Choi Yoo Jin, Jung Jae Yun, Kwon Hyuksool
Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do Department of Emergency Medicine, Seoul National University Hospital, Jongno-gu, Seoul-si, Republic of Korea.
Medicine (Baltimore). 2017 Jun;96(25):e7269. doi: 10.1097/MD.0000000000007269.
Implementation of point-of-care ultrasonography (POCUS)-assisted physical examination (PE) in emergency departments (EDs) was conducted in the ED of an urban tertiary teaching hospital. This study examines the effect of POCUS implementation in emergency medicine departments by using a systematic education program on image acquisition to analyze decision making.Educating staff on POCUS involved a technique related to image acquisition and then accurately diagnosing subsequent POCUS results. The quasi-experimental, uncontrolled before-and-after study was performed to evaluate the education effect. POCUS orders for eligible patients, length of stay (LOS) in ED, and return visits (RVs) to ED between the "before" period (March 1, 2015 to February 28, 2016) and the "after" period (March 1, 2016 to February 28, 2017) were compared. Piecewise regression was used to assess trend differences of LOS and RVs between the periods.A total of 16,942 and 16,287 patients were included in the before and after periods of education, respectively. During the study periods, 966 (6%) and 2801 (18%) POCUS were ordered, respectively (rate difference = 12%; P < .001). Before the education, the median LOS was 6.55 (interquartile rage [IQR]: 6.2-6.75) and the trend slope of LOS was -0.01. After the education, the median LOS was 5.25 (IQR: 4.85-5.45) and the trend slope (the change of which was considered significant, at a P value of .012) was -0.15. Before the education, the median RV rate was 6.4% (IQR: 6.15-6.65) and the trend slope of RVs was -0.01. After the education, the median RVs was 5.25% (IQR: 4.95-5.35) and the trend slope of RVs was also significant, at -0.11.The education of POCUS-PE in ED successfully increased use of POCUS, and reduced the LOS and RV rate in ED.
在一家城市三级教学医院的急诊科开展了床旁超声检查（POCUS）辅助体格检查（PE）。本研究通过一项关于图像采集的系统教育项目来分析决策过程，以检验POCUS在急诊科实施的效果。对工作人员进行POCUS培训涉及与图像采集相关的技术，然后准确诊断后续的POCUS结果。进行了准实验性、非对照的前后研究以评估教育效果。比较了“之前”时期（2015年3月1日至2016年2月28日）和“之后”时期（2016年3月1日至2017年2月28日）符合条件患者的POCUS检查医嘱、在急诊科的住院时间（LOS）以及返回急诊科就诊（RV）的情况。采用分段回归来评估各时期LOS和RV的趋势差异。
教育前和教育后时期分别纳入了16942例和16287例患者。在研究期间，分别开出了966例（6%）和2801例（18%）POCUS检查医嘱（率差 = 12%；P <.001）。教育前，LOS中位数为6.55（四分位间距[IQR]：6.2 - 6.75），LOS的趋势斜率为 -0.01。教育后，LOS中位数为5.25（IQR：4.85 - 5.45），趋势斜率（其变化在P值为.012时被认为具有显著性）为 -0.15。教育前，RV率中位数为6.4%（IQR：6.15 - 6.65），RV的趋势斜率为 -0.01。教育后，RV中位数为5.25%（IQR：4.95 - 5.35），RV的趋势斜率也具有显著性，为 -0.11。
急诊科POCUS - PE教育成功增加了POCUS的使用，并降低了急诊科的LOS和RV率。
