Improved diagnostic accuracy of pathology with the implementation of a perioperative point-of-care ultrasound service: quality improvement initiative
| Autor: | Dustin Wailes, Gary Stier, Matt Alschuler, Davinder Ramsingh, Ryan Lauer, Robert D. Martin, Ihab Dorotta, Briahnna Austin, Alec Runyon, Jaron Yang, Jason Gatling |
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| Rok vydání: | 2019 |
| Předmět: |
Service (systems architecture)
medicine.medical_specialty Quality management Point-of-Care Systems Physical examination Cohort Studies Education Distance 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Humans Medicine Medical physics 030212 general & internal medicine Medical diagnosis Curriculum Retrospective Studies Ultrasonography Service quality Perioperative medicine medicine.diagnostic_test business.industry General Medicine Perioperative Quality Improvement Anesthesiology and Pain Medicine Education Medical Continuing Emergency Service Hospital business |
| Zdroj: | Regional Anesthesia & Pain Medicine. :rapm-2019 |
| ISSN: | 1532-8651 1098-7339 |
| DOI: | 10.1136/rapm-2019-100632 |
| Popis: | IntroductionThe utility of perioperative point-of-care ultrasound (P-POCUS) is rapidly growing. The successful implementation of a comprehensive P-POCUS curriculum, Focused PeriOperative Risk Evaluation Sonography Involving Gastro-abdominal, Hemodynamic, and Trans-thoracic Ultrasound (FORESIGHT), has been demonstrated. This project sought to further evaluate the utility of P-POCUS with the following aims: (1) to assess the ability to train the FORESIGHT curriculum via a free, open-access, online platform; (2) to launch a P-POCUS clinical service as a quality improvement (QI) initiative; (3) to evaluate the diagnostic accuracy of the P-POCUS examinations to formal diagnostic studies; and (4) to compare the P-POCUS diagnostic accuracy with the diagnostic accuracy of traditional assessment (TA).MethodsThis study was launched as a QI project for the implementation of a P-POCUS service. A group of attending and resident anesthesiologists completed P-POCUS training supported by an online curriculum. After training, a P-POCUS service was launched. The P-POCUS service was available for any perioperative event, and specific triggers were also identified. All examinations were documented on a validated datasheet. The diagnostic accuracy of the two index tests, P-POCUS and TA, were compared with formal diagnostic testing. TA was defined as a combination of the anesthesiologist’s bedside assessment and physical examination. The primary outcome marker was a comparison in the accuracy of new diagnosis detected by P-POCUS service versus the TA performed by the primary anesthesiologist.ResultsA total of 686 P-POCUS examinations were performed with 466 examinations having formal diagnostic studies for comparison. Of these, 92 examinations were detected as having new diagnoses. Performance for detection of a new diagnosis demonstrated a statistically higher sensitivity for the P-POCUS examinations (pConclusionA P-POCUS service can be developed after training facilitated by an online curriculum. P-POCUS examinations can be performed by anesthesiologists with a high degree of accuracy to formal studies, which is superior to TA. |
| Databáze: | OpenAIRE |
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