447 - Improving Point-of-Care Ultrasound Utilization in The Pediatric Emergency Department

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 447
Publication Number: 447.312

Julie Klensch, Norton Children’s Hospital, Louisville, KY, United States; Dominique Elmore, Norton Children’s Hospital, Louisville, KY, United States; Esper Wadih, University of Louisville, Louisville, KY, United States; Johanna Said, University of Louisville/Norton Childrens Hospital, Louisville, KY, United States; Paul A. Khalil, Nicklaus Children’s Hospital, Miami, FL, United States

Presenting Author(s)

Julie Klensch, MD (she/her/hers)

Physician
Norton Children’s Hospital
Louisville, Kentucky, United States

Background: Point-of-Care Ultrasound (POCUS) utilization in the emergency department improves diagnostic accuracy, shortens length of stay, and decreases radiation exposure associated with other imaging studies. Studies have shown the success of quality improvement initiatives in increasing the use of POCUS among residents and to improve the quality of POCUS documentation in the emergency department.

Objective:

The aim of this study was to identify and address areas for improvement in POCUS use by pediatric emergency medicine (PEM) physicians. The primary objective was to increase PEM physician confidence in obtaining POCUS cardiac and lung exams and increase confidence utilizing the department’s touchscreen Mindray ultrasound machine. The secondary objective was to increase the frequency these studies were obtained.

Design/Methods: The study was a Quality Improvement (QI) project conducted at one free standing academic pediatric emergency department and one community emergency department staffed by the same physician group. Based on a pre-intervention survey, areas of interest identified included obtaining cardiac and lung POCUS scans and utilization of the Mindray ultrasound machine, a touchscreen device newer to the department. PEM fellows worked with ultrasound leadership to produce short instructional videos on the areas of interest. Videos were distributed via email and QR code attached to both ultrasound machines. Fellows performed a 5 question assessment of attendings to assure competence on Mindray utilization after intervention. Post-intervention survey to assess physician confidence before and after intervention using five-point Likert scale was then completed. A retrospective chart review of Qpath was completed to review ultrasound counts in the 6 months before intervention and the 6 months after intervention.

Results:

The initial pre-intervention survey was sent to all PEM physicians, including fellows. With responses from 23 of 30 targeted physicians, areas of interest were identified. After video intervention, 14 of 18 targeted attendings completed the 5 question competency assessment on Mindray use and 11 of 18 completed the follow up survey. Physician confidence increased on 5-point Likert scale by 0.82 for performing cardiac ultrasound, 1.27 for performing lung ultrasound, and 1.1 for using Mindray machine. Mindray use overall demonstrated a 14% increase after intervention. Total cardiac scans increased by 31%.

Conclusion(s):

This study shows that targeted POCUS educational videos can increase comfort and utilization of specific ultrasound skill of PEM physicians.