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Cardiovasc Ultrasound. 2018 Sep 11;16(1):14. doi: 10.1186/s12947-018-0132-0.

When to incorporate point-of-care ultrasound (POCUS) into the initial assessment of acutely ill patients: a pilot crossover study to compare 2 POCUS-assisted simulation protocols.

Author information

1
Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. bennett.courtney@mayo.edu.
2
Division of Pulmonary and Critical Care Medicine, Rochester, USA.
3
Division of Pulmonary and Critical Care, Sinai Health System, Chicago, IL, USA.
4
Departments of Emergency Medicine and Pulmonary and Critical Care, Henry Ford Hospital, Detroit, MI, USA.
5
Mayo Clinic, Rochester, MN, USA.
6
Emergency Services, Rochester, USA.
7
Mayo Clinic Health System in Austin, Austin, MN, USA.
8
Division of Health Care Policy and Research, Rochester, USA.

Abstract

BACKGROUND:

The purpose of this study was to determine the ideal timing for providers to perform point-of-care ultrasound (POCUS) with the least increase in workload.

METHODS:

We conducted a pilot crossover study to compare 2 POCUS-assisted evaluation protocols for acutely ill patients: sequential (physical examination followed by POCUS) vs parallel (POCUS at the time of physical examination). Participants were randomly assigned to 2 groups according to which POCUS-assisted protocol (sequential vs parallel) was used during simulated scenarios. Subsequently, the groups were crossed over to complete assessment by using the other POCUS-assisted protocol in the same patient scenarios. Providers' workloads, measured with the National Aeronautics and Space Administration Task Load Index (NASA-TLX) and time to complete patient evaluation, were compared between the 2 protocols.

RESULTS:

Seven providers completed 14 assessments (7 sequential and 7 parallel). The median (IQR) total NASA-TLX score was 30 (30-50) in the sequential and 55 (50-65) in the parallel protocol (P = .03), which suggests a significantly lower workload in the sequential protocol. When individual components of the NASA-TLX score were evaluated, mental demand and frustration level were significantly lower in the sequential than in the parallel protocol (40 [IQR, 30-60] vs 50 [IQR, 40-70]; P = .03 and 25 [IQR, 20-35] vs 60 [IQR, 45-85]; P = .02, respectively). The time needed to complete the assessment was similar between the sequential and parallel protocols (8.7 [IQR, 6-9] minutes vs 10.1 [IQR, 7-11] minutes, respectively; P = .30).

CONCLUSIONS:

A sequential POCUS-assisted protocol posed less workload to POCUS operators than the parallel protocol.

KEYWORDS:

Critical illness; Point-of-care; Simulation; Ultrasound

PMID:
30200973
PMCID:
PMC6131841
DOI:
10.1186/s12947-018-0132-0
[Indexed for MEDLINE]
Free PMC Article

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