Yorkgitis Brian K, Bryant Elizabeth A, Brat Gabriel A, Kelly Edward, Askari Reza, Ra Jin H
Division of Acute Care Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida.
Injury Prevention and Outreach Coordinator, Brigham and Women's Hospital, Trauma, Burns, and Surgical Critical Care, Boston, Massachusetts.
J Surg Res. 2017 Oct;218:292-297. doi: 10.1016/j.jss.2017.06.040. Epub 2017 Jul 11.
Intensivist-performed ultrasound (IPUS) is an adjunctive tool used to assist in resuscitation and management of critically ill patients. It allows clinicians real-time information through noninvasive methods. We aimed to evaluate the types of IPUS performed and the methods surgical critical care (SCC) fellows are trained along with challenges in training.
One hundred SCC fellowship directors were successfully sent an email inviting them to participate in a short Web-based survey. We inquired about program characteristics including hospital type, fellowship size, faculty size and training, dedicated surgical critical care beds, and ultrasound equipment availability. The survey contained questions regarding the program directors' perception on importance on cost effectiveness of IPUS, types of IPUS examinations performed, fellows experience with IPUS, challenges to training, and presence and methods of quality assurance (QA) programs.
A total of 38 (38.0%) program directors completed the survey. Using a 100-point Likert scale, the majority of the respondents indicated that IPUS is important to patient care in the SICU and is cost-effective (mean score 85.5 and 84.6, respectively). Most (34, 89.5%) utilize IPUS and conduct a mean of 5.1 different examination types with FAST being the most prevalent examination (33, 86.8%). Thirty-three (86.8%) programs include IPUS in their SCC training with varying amounts of time spent training. Of these programs, 19 (57.6%) have a specific curriculum. The most frequently used modalities for training fellows were informal bedside teaching (28, 84.8%), hands-on lectures (20, 60.6%) and formal lectures (19, 57.6%). The top three challenges program directors cited for IPUS education was time (23, 69.7%), followed by concerns for ongoing QA (19, 57.6%) and lack of faculty trained in IPUS (18, 53.9%). Only 20 (60.6%) programs review images as a part of QA/quality improvement.
Utilization and training of IPUS is common in SCC fellowships. There is varied education type and training time devoted to IPUS which could lead to gaps in knowledge and care. Development of a standard curriculum for SCC fellowships could assist surgical intensivists in achieving a base of knowledge in IPUS to create a more homogenously trained workforce and standards of care.
重症监护医生实施的超声检查（IPUS）是一种辅助工具，用于协助对危重症患者进行复苏和管理。它通过非侵入性方法为临床医生提供实时信息。我们旨在评估所实施的IPUS类型、外科重症监护（SCC）专科住院医生的培训方法以及培训中的挑战。
成功向100名SCC专科住院医生培训项目主任发送电子邮件，邀请他们参与一项简短的基于网络的调查。我们询问了项目特征，包括医院类型、专科住院医生人数、教员人数及培训情况、专用的外科重症监护病床数量以及超声设备的可获得性。该调查包含有关项目主任对IPUS成本效益重要性的看法、所实施的IPUS检查类型、专科住院医生的IPUS经验、培训挑战以及质量保证（QA）项目的存在情况和方法等问题。
共有38名（38.0%）项目主任完成了调查。使用100分的李克特量表，大多数受访者表示IPUS对外科重症监护病房（SICU）的患者护理很重要且具有成本效益（平均得分分别为85.5和84.6）。大多数（34名，89.5%）使用IPUS，平均进行5.1种不同类型的检查，其中快速扫查（FAST）是最常见的检查（33名，86.8%）。33个（86.8%）项目在其SCC培训中纳入了IPUS，培训时间各不相同。在这些项目中，19个（57.6%）有特定的课程。培训专科住院医生最常用的方式是床边非正式教学（28名，84.8%）、实践讲座（20名，60.6%）和正式讲座（19名，57.6%）。项目主任提到的IPUS教育的三大挑战是时间（23名，69.7%），其次是对持续质量保证的担忧（19名，57.6%）和缺乏接受过IPUS培训的教员（18名，53.9%）。只有20个（60.6%）项目将图像审查作为质量保证/质量改进的一部分。
IPUS的使用和培训在SCC专科住院医生培训项目中很常见。IPUS的教育类型和培训时间各不相同，这可能导致知识和护理方面的差距。为SCC专科住院医生培训项目制定标准课程可以帮助外科重症监护医生获得IPUS方面的基础知识，以培养一支训练更加同质化的队伍并建立护理标准。
