Patrick David Peter, Bradley Xenia Gia, Wolek Caroline, Anderson Bowen, Grady James, Herbst Meghan Kelly
University of Connecticut School of Medicine Farmington Connecticut USA.
Department of Public Health Sciences University of Connecticut School of Medicine Farmington Connecticut USA.
AEM Educ Train. 2023 Aug 18;7(4):e10901. doi: 10.1002/aet2.10901. eCollection 2023 Aug.
While point-of-care ultrasound (PoCUS) is a safe, versatile tool that can improve patient care, the perceived time investment needed to incorporate PoCUS into clinical care is cited as a barrier to performance. We sought to determine the time it takes to perform a PoCUS examination and whether this time was influenced by training level and prior ultrasound experience.
This was a retrospective study looking at time stamps of all emergency medicine (EM) provider-performed PoCUS examinations during clinical shifts from August 10, 2019, to June 7, 2022, at a suburban academic emergency department that is the site for a 3-year EM residency. Our workflow is order-based; when PoCUS is ordered, that patient's information populates the ultrasound machine worklist. Selecting the patient's name from the worklist generates a time-stamped patient information page (PIP). We defined the PIP time stamp as the start of the PoCUS examination. The duration of one PoCUS examination was defined as the time of the last image acquired minus the time of the PIP. General estimating equations were used to estimate differences between training level and between prior scan status using an exchangeable correlation and Tukey adjusted pairwise comparisons. A two-tailed chi-square analysis was used for comparing accuracy according to training level.
Of 4187 PoCUS examinations abstracted, 2144 met study criteria. The median (IQR) time spent per examination was 6.0 (3-9) min. First-year residents took the longest to perform PoCUS among all providers ( < 0.0001). Residents with fewer than 250 prior scans took longer than residents with 501-800 ( = 0.0002) and >800 ( = 0.0013). Resident accuracy was not significantly different according to training level.
Overall median time to perform PoCUS was 6.0 min. EM residents became more efficient in performing PoCUS as they advanced from first- to third-year, without compromising accuracy.
即时超声检查（PoCUS）是一种安全、多功能的工具，可改善患者护理，但将PoCUS纳入临床护理所需的时间投入被认为是其应用的一个障碍。我们试图确定进行一次PoCUS检查所需的时间，以及这个时间是否受培训水平和既往超声检查经验的影响。
这是一项回顾性研究，观察了2019年8月10日至2022年6月7日在一家郊区学术急诊科临床轮班期间，所有急诊医学（EM）提供者进行的PoCUS检查的时间戳。该急诊科是一个为期三年的EM住院医师培训基地。我们的工作流程是基于医嘱的；当开出PoCUS检查医嘱时，该患者的信息会填充到超声机器的工作列表中。从工作列表中选择患者姓名会生成一个带有时间戳的患者信息页面（PIP）。我们将PIP时间戳定义为PoCUS检查的开始时间。一次PoCUS检查的持续时间定义为最后采集图像的时间减去PIP的时间。使用广义估计方程，采用可交换相关性和Tukey调整后的成对比较来估计培训水平之间以及既往扫描状态之间的差异。采用双尾卡方分析根据培训水平比较准确性。
在提取的4187次PoCUS检查中，2144次符合研究标准。每次检查的中位（IQR）时间为6.0（3 - 9）分钟。在所有提供者中，一年级住院医师进行PoCUS检查花费的时间最长（<0.0001）。既往扫描次数少于250次的住院医师比既往扫描次数在501 - 800次（=0.0002）和>800次（=0.0013）的住院医师花费的时间更长。住院医师的准确性根据培训水平没有显著差异。
进行PoCUS检查的总体中位时间为6.0分钟。EM住院医师从一年级到三年级，在进行PoCUS检查时效率越来越高，且不影响准确性。
