Jurnal Internasional Afrika vol.9 issue.3 2019
African Journal of Emergency Medicine
Rapid, remote education for point-of-care ultrasound among non physician emergency care providers in a resource limited setting
Dublin Core
Title
Jurnal Internasional Afrika vol.9 issue.3 2019
African Journal of Emergency Medicine
Rapid, remote education for point-of-care ultrasound among non physician emergency care providers in a resource limited setting
African Journal of Emergency Medicine
Rapid, remote education for point-of-care ultrasound among non physician emergency care providers in a resource limited setting
Subject
ultrasound;non-physician
quality assurance
Hydroxyl radicals
remote feedback
quality assurance
Hydroxyl radicals
remote feedback
Description
Introduction: Access to high-quality emergency care in low- and middle-income countries (LMIC) is lacking.
Many countries utilise a strategy known as “task-shifting” where skills and responsibilities are distributed in
novel ways among healthcare personnel. Point-of-care ultrasound (POCUS) has the potential to significantly
improve emergency care in LMICs.
Methods: POCUS was incorporated into a training program for a ten-person cohort of non-physician Emergency
Care Providers (ECPs) in rural Uganda. We performed a prospective observational evaluation on the impact of a
remote, rapid review of POCUS studies on the primary objective of ECP ultrasound quality and secondary objective
of ultrasound utilisation. The study was divided into four phases over 11 months: an initial in-person training
month, two middle month blocks where ECPs performed ultrasounds independently without remote electronic
feedback, and the final months when ECPs performed ultrasounds independently with remote electronic feedback.
Quality was assessed on a previously published eight-point ordinal scale by a U.S.-based expert sonographer and
rapid standardised feedback was given to ECPs by local staff. Sensitivity and specificity of ultrasound exam
findings for the Focused Assessment with Sonography for Trauma (FAST) was calculated.
Results: Over the study duration, 1153 ultrasound studies were reviewed. Average imaging frequency per ECP
dropped 61% after the initial in-person training month (p = 0.01) when ECPs performed ultrasound independently,
but rebounded once electronic feedback was initiated (p = 0.001), with an improvement in quality from 3.82 (95%
CI, 3.32–4.32) to 4.68 (95% CI, 4.35–5.01) on an eight-point scale. The sensitivity and specificity of FAST exam
during the initial training period was 77.8 (95% CI, 59.2–83.0) and 98.5 (95% CI, 93.3–99.9), respectively.
Sensitivity improved 88% compared to independent, non-feedback months whereas specificity was unchanged.
Conclusions: Remotely delivered quality assurance feedback is an effective educational tool to enhance provider
skill and foster continued and sustainable use of ultrasound in LMICs.
Many countries utilise a strategy known as “task-shifting” where skills and responsibilities are distributed in
novel ways among healthcare personnel. Point-of-care ultrasound (POCUS) has the potential to significantly
improve emergency care in LMICs.
Methods: POCUS was incorporated into a training program for a ten-person cohort of non-physician Emergency
Care Providers (ECPs) in rural Uganda. We performed a prospective observational evaluation on the impact of a
remote, rapid review of POCUS studies on the primary objective of ECP ultrasound quality and secondary objective
of ultrasound utilisation. The study was divided into four phases over 11 months: an initial in-person training
month, two middle month blocks where ECPs performed ultrasounds independently without remote electronic
feedback, and the final months when ECPs performed ultrasounds independently with remote electronic feedback.
Quality was assessed on a previously published eight-point ordinal scale by a U.S.-based expert sonographer and
rapid standardised feedback was given to ECPs by local staff. Sensitivity and specificity of ultrasound exam
findings for the Focused Assessment with Sonography for Trauma (FAST) was calculated.
Results: Over the study duration, 1153 ultrasound studies were reviewed. Average imaging frequency per ECP
dropped 61% after the initial in-person training month (p = 0.01) when ECPs performed ultrasound independently,
but rebounded once electronic feedback was initiated (p = 0.001), with an improvement in quality from 3.82 (95%
CI, 3.32–4.32) to 4.68 (95% CI, 4.35–5.01) on an eight-point scale. The sensitivity and specificity of FAST exam
during the initial training period was 77.8 (95% CI, 59.2–83.0) and 98.5 (95% CI, 93.3–99.9), respectively.
Sensitivity improved 88% compared to independent, non-feedback months whereas specificity was unchanged.
Conclusions: Remotely delivered quality assurance feedback is an effective educational tool to enhance provider
skill and foster continued and sustainable use of ultrasound in LMICs.
Creator
Benjamin Terry, David L. Polan, Rashidah Nambaziira, Julius Mugisha, Mark Bisanzo, Romolo Gasparia
Source
https://doi.org/10.1016/j.afjem.2019.05.004
Date
17 May 2019
Contributor
peri irawan
Format
pdf
Language
ENGLISH
Type
text
Files
Citation
Benjamin Terry, David L. Polan, Rashidah Nambaziira, Julius Mugisha, Mark Bisanzo, Romolo Gasparia, “Jurnal Internasional Afrika vol.9 issue.3 2019
African Journal of Emergency Medicine
Rapid, remote education for point-of-care ultrasound among non physician emergency care providers in a resource limited setting,” Repository Horizon University Indonesia, accessed November 21, 2024, https://repository.horizon.ac.id/items/show/1762.
African Journal of Emergency Medicine
Rapid, remote education for point-of-care ultrasound among non physician emergency care providers in a resource limited setting,” Repository Horizon University Indonesia, accessed November 21, 2024, https://repository.horizon.ac.id/items/show/1762.