Glogoza Matt, Urbach Jonathan, Rosborough Terry K, Olet Susan, St Hill Catherine A, Smith Claire S, Tierney David M
Department of Graduate Medical Education #11135, Abbott Northwestern Hospital, 800 E. 28th Street, Minneapolis, MN, 55407, USA.
Clinical Research Informatics and Analytics, Allina Health, Minneapolis, MN, USA.
Ultrasound J. 2020 Apr 16;12(1):18. doi: 10.1186/s13089-020-00165-8.
Point-of-care ultrasound (POCUS) is becoming an important part of internal medicine (IM) residency training. Achieving competency requires performing a large volume of clinical exams which can be difficult within the constraints of residency. Often-cited barriers include insufficient resident time and the interruption of daily workflow. Despite availability of hospital station-based laptop ultrasound machines, we hypothesized that the addition of ward team-based tablet ultrasound devices would lower barriers and increase clinical POCUS volume within an IM residency POCUS curriculum at a 670-bed, quaternary care, teaching hospital. IM resident POCUS volumes and characteristics during an 18-mo. baseline (station-based laptop devices only) period were compared to matched months during the intervention (station-based + tablet).
Total patients examined with POCUS by 6 inpatient resident teams during the 18-mo. baseline and intervention periods were 1386 and 1853, respectively. Patients examined per month increased during the intervention by 34% (77 vs. 103, p = 0.002). The number of areas (e.g., abdominal, cardiac) and items (e.g., bladder, pericardial effusion) examined per month increased by 27% (p = 0.021) and 23% (p = 0.073), respectively.
A combined program infrastructure of station-based laptop and "in-the-pocket" tablet ultrasound devices lowered common POCUS barriers of inadequate time and workflow disruption for IM residents and resulted in a meaningful increase of exams within a longitudinal residency-based training program where station-based laptop devices already existed.
床旁超声（POCUS）正成为内科住院医师培训的重要组成部分。要达到胜任水平需要进行大量临床检查，而在住院医师培训的限制条件下这可能具有挑战性。经常被提及的障碍包括住院医师时间不足以及日常工作流程的中断。尽管医院有基于工作站的笔记本超声设备，但我们推测，在一家拥有670张床位的四级医疗教学医院的内科住院医师POCUS课程中，增加基于病房团队的平板超声设备将降低障碍并增加临床POCUS检查量。比较了18个月基线期（仅使用基于工作站的笔记本设备）和干预期（基于工作站的设备 + 平板）内科住院医师POCUS检查量及特征。
在18个月的基线期和干预期，6个住院医师团队使用POCUS检查的患者总数分别为1386例和1853例。干预期间每月检查患者数增加了34%（77例对103例，p = 0.002）。每月检查的区域（如腹部、心脏）和项目（如膀胱、心包积液）数量分别增加了27%（p = 0.021）和23%（p = 0.073）。
基于工作站的笔记本电脑和平板超声设备的组合方案基础设施降低了内科住院医师进行POCUS检查时常见的时间不足和工作流程中断的障碍，并在已有基于工作站笔记本设备的纵向住院医师培训项目中显著增加了检查量。
