在急诊住院医师培训中开展床边心脏超声项目：一项基于绩效改进视角的回顾性观察研究。

Operating bedside cardiac ultrasound program in emergency medicine residency: A retrospective observation study from the perspective of performance improvement.

机构信息

Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea.

出版信息

PLoS One. 2021 Apr 2;16(4):e0248710. doi: 10.1371/journal.pone.0248710. eCollection 2021.

DOI:10.1371/journal.pone.0248710

PMID:33798217

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8018668/

Abstract

BACKGROUND

Point-of-care ultrasound is one of useful diagnostic tools in emergency medicine practice and considerably depends on physician's performance. This study was performed to evaluate performance improvements and favorable attitudes through structured cardiac ultrasound program for emergency medicine residents.

METHODS

Retrospective observational study using the point-of-care ultrasound (PoCUS) database in one tertiary academic-teaching hospital emergency department has been conducted. Cardiac ultrasound education and rotation program has been implemented in emergency medicine residency program. Structured evaluation sheet for cardiac ultrasound and questionnaire toward PoCUS have been developed. An early-phase and a late-phase case were selected randomly for each participant. Two emergency medicine specialists with expertise in PoCUS evaluated saved images independently. We used a paired t-test to compare the performance score of each phase and the results of the questionnaire. Multivariable linear regression analysis was conducted to evaluate the association between the characteristics of participants and performance improvements.

RESULTS

During the study period, a total of 1,652 bedside cardiac ultrasounds were administered. Forty-six examinations conducted by 23 emergency medicine residents were randomly selected for analysis. The performance score increased from 39.5 to 56.1 according to expert A and 45.3 to 62.9 according to expert B (p-value <0.01 for both). The average questionnaire score, which was analyzed for 17 participants, showed improvement from 18.9 to 20.7 (p-value <0.01). In multivariable linear regression analysis, younger age, higher early-phase score and higher confidence had a negative association with a greater improvement of performance, while the number of examinations had a positive association.

CONCLUSIONS

Bedside cardiac ultrasound performance and attitudes toward PoCUS have been improved through structured residency program.

摘要

背景

床旁超声是急诊医学实践中一种有用的诊断工具，在很大程度上取决于医生的表现。本研究旨在评估通过急诊住院医师心脏超声项目提高表现和培养积极态度的效果。

方法

对一家三级学术教学医院急诊部的床旁超声（PoCUS）数据库进行回顾性观察研究。在急诊住院医师培训计划中实施了心脏超声教育和轮转计划。制定了用于心脏超声的结构化评估表和 PoCUS 问卷。为每位参与者随机选择了一个早期阶段和一个晚期阶段的病例。两位具有 PoCUS 专业知识的急诊专家独立评估保存的图像。我们使用配对 t 检验比较每个阶段的表现评分和问卷结果。进行多变量线性回归分析，以评估参与者特征与表现改善之间的关联。

结果

在研究期间，共进行了 1652 次床边心脏超声检查。随机选择了 23 名急诊住院医师进行的 46 次检查进行分析。根据专家 A，表现评分从 39.5 分提高到 56.1 分，根据专家 B，表现评分从 45.3 分提高到 62.9 分（均为 p 值<0.01）。对 17 名参与者进行了平均问卷评分分析，结果显示从 18.9 分提高到 20.7 分（p 值<0.01）。多变量线性回归分析显示，年龄较小、早期阶段评分较高和信心较高与表现改善程度较大呈负相关，而检查次数与表现改善程度较大呈正相关。