Training Module Boosted Bedside Ultrasound Exams

ACEP News
June 2010

By Doug Brunk
Elsevier Global Medical News



SAN DIEGO -- After a simple training intervention, emergency physicians at a large tertiary-care hospital performed more than twice as many focused bedside ultrasound exams on pregnant patients.

"Pregnant women who get the ultrasound by the emergency physician are usually in and out of the department in 20-30 minutes," Dr. Michael Antonis said in an interview during a poster session at the annual meeting of the American Institute for Ultrasound in Medicine.

"Basically, you're looking for a heartbeat and anything worrisome in the adnexa," explained Dr. Antonis, ultrasound fellowship director at the Georgetown University/Washington Hospital Center's emergency medicine residency program, Washington, D.C.

"With those questions answered, they're out the door in 20-30 minutes," Dr. Antonis noted. "You don't have to send them to radiology. It's something that's done right at the bedside."

In a 9-month study led by Dr. Antonis' associate Dr. Elizabeth Pontius, a third-year resident in the emer-gency medicine residency program, researchers developed a training program for attending physicians in the ED.

The program consisted of two modules: an online training module on how to use the bedside ultra-sound machine in general, and a second training module describing how to use the machine for transabdominal and endocavity scans during pregnancy.

Next, the attending physicians were assigned to dedicated "sounding" shifts with Dr. Antonis and Dr. Carolyn Phillips, also of Washington Hos-pital Center, in which they learned how to perform focused ultrasound exams.

After that training, Dr. Antonis and his associates reviewed all ultrasound exams during weekly quality-assurance reviews, and the total number of scans performed by each physician during the intervention period was counted.

Before the intervention period, 31 physicians had performed a total of 645 transabdominal or endocavity pregnancy ultrasound exams.

After the intervention, 34 physicians had performed 2,350 exams. That translated into a 264% increase in the number of scans performed during the 9-month intervention.

"We could probably increase those numbers even more, because now we have a full year of data," Dr. Pontius commented. "It would be interesting to go back and see if that has improved."

One limitation of the study, she added, is that not all physicians were open to learning how to perform bedside ultrasound exams.

"Some physicians readily embrace this technology and are excited and eager to learn it; others are less so," Dr. Pontius said.

"Even though we were able to increase our numbers so much, we could have even more improvement if we were able to really get all of our physicians invested in bedside ultrasound," Dr. Pontius added.

Dr. Antonis and Dr. Pontius hadno relevant financial conflicts to disclose.

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