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1
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Boivin Z. Letter to the editor regarding 'does point-of-care ultrasound examination by the general practitioner lead to inappropriate care? A follow-up study'. Scand J Prim Health Care 2025:1-2. [PMID: 40293723 DOI: 10.1080/02813432.2025.2499172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2025] [Accepted: 04/23/2025] [Indexed: 04/30/2025] Open
Affiliation(s)
- Zachary Boivin
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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2
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Heidepriem KW. Medical Malpractice Epidemiology: Adults and Pediatrics. Emerg Med Clin North Am 2025; 43:19-28. [PMID: 39515940 DOI: 10.1016/j.emc.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
For emergency medicine physicians, being named in a malpractice suit is not an if, it is a when. By the age of 55 years, 68% of emergency physicians have been sued. In the following article, we review the most common factors shared by closed claims in adult and pediatric patients from emergency departments and acute care settings. Our hope is that by identifying shared characteristics, we may improve patient care and reduce litigation risk.
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Affiliation(s)
- Kelly Wong Heidepriem
- Department of Family Medicine, University of South Dakota Sanford School of Medicine, 1400 West 22nd Street, Sioux Falls, SD 57105, USA.
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3
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Ma IWY, Wagner M. Principles and Practice of Internal Medicine Point-of-Care Ultrasound. Med Clin North Am 2025; 109:1-9. [PMID: 39567086 DOI: 10.1016/j.mcna.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2024]
Abstract
While point-of-care ultrasound (POCUS) use is expanding within Internal Medicine, basic yet important practices and key infrastructure are frequently underutilized. This is appropriately raising concerns that patients may be unintentionally harmed by POCUS. To mitigate this risk, this article advocates for ensuring POCUS users have adequate training to include understanding limitations and pitfalls arising from acquisition, interpretation, and clinical integration. It is also important to build infrastructure to allow for ongoing monitoring and quality assurance with an emphasis on transparency and objectivity of the clinician's POCUS findings. This will ensure the safe and effective integration of POCUS in Internal Medicine.
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Affiliation(s)
- Irene W Y Ma
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive Northwest, Calgary, Alberta T2N 4N1, Canada.
| | - Michael Wagner
- Department of Medicine, University of South Carolina School of Medicine-Greenville, 701 Grove Road, Hospitalist Division 5th Floor Support Tower, Greenville, SC 29605, USA
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4
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Sinanan R, Moshtaghi A, Koratala A. Point-of-care ultrasound in nephrology: A private practice viewpoint. World J Methodol 2024; 14:95685. [PMID: 39712563 PMCID: PMC11287536 DOI: 10.5662/wjm.v14.i4.95685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/28/2024] [Accepted: 07/05/2024] [Indexed: 07/26/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is a limited ultrasound examination performed by the clinician at the bedside, emerging as a complement to physical examination across various medical specialties. In the field of nephrology, its integration has been gradual, primarily limited to guiding procedures like temporary dialysis catheter placement or, in some cases, diagnostic kidney ultrasounds. In reality, the assessment of hemodynamic status at the bedside holds immense value for nephrologists, yet there exists limited awareness among practitioners regarding its implementation. While there is a growing trend towards incorporating multi-organ POCUS training in fellowship programs, private practice nephrologists remain relatively uninformed. This discussion explores the untapped potential of POCUS as a valuable diagnostic tool in everyday nephrology practice, demonstrating its effectiveness in diverse clinical settings, ranging from medical wards to outpatient dialysis units. Additionally, we delve into the challenges hindering its widespread adoption and consider the future trajectory of this innovative approach.
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Affiliation(s)
- Rajiv Sinanan
- Arizona Kidney Disease and Hypertension Centers, Phoenix, AZ 85016, United States
| | - Afsheen Moshtaghi
- Department of Medicine, Verde Valley Medical Center, Cottonwood, AZ 86326, United States
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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5
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Tarakçıoğlu ZE, Özdemir B, Sutaşır MN. Evaluation of problems arising in emergency services from the perspectives of medical and criminal law: The example of Türkiye. Heliyon 2024; 10:e39492. [PMID: 39641060 PMCID: PMC11617735 DOI: 10.1016/j.heliyon.2024.e39492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 08/02/2024] [Accepted: 10/15/2024] [Indexed: 12/07/2024] Open
Abstract
Introduction In recent years, the field of medical malpractice has attracted growing attention, and despite the long history of research in this area, aspects of this phenomenon remain unexplored. In this paper, we aimed to explore the issue of medical malpractice, focusing on cases involving healthcare professionals working in emergency services in Türkiye. We examine the surge in medical malpractice lawsuits, the consequences of such cases, and the prevalence of criminal liability faced by healthcare professionals. Materials and methods A comprehensive analysis of healthcare-related cases from 2017 to 2022 was carried out using the electronic decision database "LEGALBANK." We scrutinized these cases from both medical and criminal law perspectives, aiming to shed light on the complex dynamics of medical malpractice in emergency services. Results The findings reveal that professionals in emergency services are confronted with a considerable number of criminal cases. Among these cases, doctors are the most frequently implicated, followed by nurses, midwives, ambulance drivers, and other healthcare professionals. The crimes attributed to these professionals vary but primarily include involuntary manslaughter, misuse of public duty, forgery of documents, and reckless injury. Discussion In Türkiye, there is a notable prevalence of investigations conducted in emergency services and criminal cases involving healthcare professionals in this field. This dual prominence underscores the unique significance of examining medical malpractice from the perspectives of both criminal law and medicine within the Turkish context. This study categorizes the multifaceted challenges of medical malpractice as human-related, system-related, and legal, offering valuable insights into the intricate landscape of this phenomenon in Türkiye's emergency services. Conclusion This research contributes to a deeper understanding of medical malpractice, particularly its criminal dimensions in the Turkish context, and thereby calls for improved healthcare, enhanced patient safety, and error prevention in emergency settings.
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Affiliation(s)
- Zeynep Esra Tarakçıoğlu
- Division of Legal Studies, Department of Political Science and Public Administration, Hacettepe University, Ankara, 06800, Turkiye
| | - Bora Özdemir
- Department of Forensic Medicine, Nigde Omer Halisdemir University, Nigde, 51240, Turkiye
| | - Mehmet Necmeddin Sutaşır
- Department of Emergency Medicine, Hamidiye Etfal Training and Research Hospital, Istanbul, 34371, Turkiye
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6
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Goudelin M, Evrard B, Donisanu R, Gonzalez C, Truffy C, Orabona M, Galy A, Lapébie FX, Jamilloux Y, Vandeix E, Belcour D, Hodler C, Ramirez L, Gagnoud R, Chapellas C, Vignon P. Therapeutic impact of basic critical care echocardiography performed by residents after limited training. Ann Intensive Care 2024; 14:119. [PMID: 39073505 PMCID: PMC11286607 DOI: 10.1186/s13613-024-01354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND The objective was to assess the agreement between therapeutic proposals derived from basic critical care echocardiography performed by novice operators in ultrasonography after a limited training (residents) and by experts considered as reference. Secondary objectives were to assess the agreement between operators' answers to simple clinical questions and the concordance between basic two-dimensional measurements. METHODS This observational, prospective, single-center study was conducted over a 3-year period in a medical-surgical intensive care unit. Adult patients with acute circulatory and/or respiratory failure requiring a transthoracic echocardiography (TTE) examination were studied. In each patient, a TTE was performed by a resident novice in ultrasonography after a short training program and by an expert, independently but within 1 h and in random order. Each operator addressed standardized simple clinical questions and subsequently proposed a therapeutic strategy based on a predefined algorithm. RESULTS Residents performed an average of 33 TTE studies in 244 patients (156 men; age: 63 years [52-74]; SAPS2: 45 [34-59]; 182 (75%) mechanically ventilated). Agreement between the therapeutic proposals of residents and experienced operators was good-to-excellent. The concordance was excellent for suggesting fluid loading, inotrope or vasopressor support (all Kappa values > 0.80). Inter-observer agreement was only moderate when considering the indication of negative fluid balance (Kappa: 0.65; 95% CI 0.50-0.80), since residents proposed diuretics in 23 patients (9.5%) while their counterparts had the same suggestion in 35 patients (14.4%). Overall agreement of responses to simple clinical questions was also good-to-excellent. Intraclass correlation coefficient exceeded 0.75 for measurement of ventricular and inferior vena cava size. CONCLUSIONS A limited training program aiming at acquiring the basic level in critical care echocardiography enables ICU residents novice in ultrasonography to propose therapeutic interventions with a good-to-excellent agreement with experienced operators.
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Affiliation(s)
- Marine Goudelin
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
- Inserm CIC1435, 87000, Limoges, France
| | - Bruno Evrard
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
- Inserm CIC1435, 87000, Limoges, France
| | - Roxana Donisanu
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Céline Gonzalez
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Christophe Truffy
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Marie Orabona
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Antoine Galy
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | | | - Yvan Jamilloux
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Elodie Vandeix
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Dominique Belcour
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Charles Hodler
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Lucie Ramirez
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Rémi Gagnoud
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Catherine Chapellas
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Philippe Vignon
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France.
- Inserm CIC1435, 87000, Limoges, France.
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7
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Prager R, Wu D, Garber G, Finestone PJ, Zang C, Aslanova R, Arntfield R. Medico-legal risks of point-of-care ultrasound: a closed-case analysis of Canadian Medical Protective Association medico-legal cases. Ultrasound J 2024; 16:16. [PMID: 38396310 PMCID: PMC10891006 DOI: 10.1186/s13089-024-00364-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) has become a core diagnostic tool for many physicians due to its portability, excellent safety profile, and diagnostic utility. Despite its growing use, the potential risks of POCUS use should be considered by providers. We analyzed the Canadian Medical Protective Association (CMPA) repository to identify medico-legal cases arising from the use of POCUS. METHODS We retrospectively searched the CMPA closed-case repository for cases involving diagnostic POCUS between January 1st, 2012 and December 31st, 2021. Cases included civil-legal actions, medical regulatory authority (College) cases, and hospital complaints. Patient and physician demographics, outcomes, reason for complaint, and expert-identified contributing factors were analyzed. RESULTS From 2012 to 2021, there were 58,626 closed medico-legal cases in the CMPA repository with POCUS determined to be a contributing factor for medico-legal action in 15 cases; in all cases the medico-legal outcome was decided against the physicians. The most common reasons for patient complaints were diagnostic error, deficient assessment, and failure to perform a test or intervention. Expert analysis of these cases determined the most common contributing factors for medico-legal action was failure to perform POCUS when indicated (7 cases, 47%); however, medico-legal action also resulted from diagnostic error, incorrect sonographic approach, deficient assessment, inadequate skill, inadequate documentation, or inadequate reporting. CONCLUSIONS Although the most common reason associated with the medico-legal action in these cases is failure to perform POCUS when indicated, inappropriate use of POCUS may lead to medico-legal action. Due to limitations in granularity of data, the exact number of civil-legal, College cases, and hospital complaints for each contributing factor is unavailable. To enhance patient care and mitigate risk for providers, POCUS should be carefully integrated with other clinical information, performed by providers with adequate skill, and carefully documented.
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Affiliation(s)
- Ross Prager
- Division of Critical Care, Western University, London, Ontario, Canada.
- London Health Sciences Centre, Rm # D2-528, 800 Commissioners Rd. E., London, ON, N6A 5W9, Canada.
| | - Derek Wu
- Department of Medicine, Western University, London, Ontario, Canada
| | - Gary Garber
- Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - P J Finestone
- Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Cathy Zang
- Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Rana Aslanova
- Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Robert Arntfield
- Division of Critical Care, Western University, London, Ontario, Canada
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Koratala A, Kazory A. Seeing through the myths: Practical aspects of diagnostic point-of-care ultrasound in nephrology. World J Nephrol 2023; 12:112-119. [PMID: 38230300 PMCID: PMC10789085 DOI: 10.5527/wjn.v12.i5.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/16/2023] [Accepted: 11/08/2023] [Indexed: 12/22/2023] Open
Abstract
Point of care ultrasonography (POCUS) is emerging as an invaluable tool for guiding patient care at the bedside, providing real-time diagnostic information to clinicians. Today, POCUS is recognized as the fifth pillar of bedside clinical examination, alongside inspection, palpation, percussion, and auscultation. In spite of growing interest, the adoption of diagnostic POCUS in nephrology remains limited, and comprehensive training beyond kidney ultrasound is offered in only a few fellowship programs. Moreover, several misconceptions and barriers surround the integration of POCUS into day-to-day nephrology practice. These include myths about its scope, utility, impact on patient outcomes and legal implications. In this minireview, we address some of these issues to encourage wider and proper utilization of POCUS.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Wauwatosa, WI 53226, United States
| | - Amir Kazory
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL 32610, United States
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9
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Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med 2023; 82:e115-e155. [PMID: 37596025 DOI: 10.1016/j.annemergmed.2023.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 08/20/2023]
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10
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Elhassan MG, Grewal S, Nezarat N. Point-of-Care Ultrasonography in Internal Medicine: Limitations and Pitfalls for Novice Users. Cureus 2023; 15:e43655. [PMID: 37600433 PMCID: PMC10436027 DOI: 10.7759/cureus.43655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 08/22/2023] Open
Abstract
Point-of-care ultrasound (POCUS) is increasingly being adopted in the field of internal medicine, leading to the development of POCUS curricula in undergraduate and postgraduate medical education programs. Prominent internal medicine societies and organizations worldwide recognize the expanding utilization of POCUS by internal medicine physicians, emphasizing the need for practitioners to be aware of both its benefits and limitations. Despite the growing enthusiasm for POCUS, clinicians, particularly those with limited clinical experience, must be cautious regarding its inherent limitations and the potential impact on their clinical practice. This review aims to outline the limitations and potential drawbacks of POCUS for medical students, residents, and internists who wish to stay abreast of the escalating use of POCUS in internal medicine and have a desire, or have already commenced, to incorporate POCUS into their practice. Additionally, it provides recommendations for enhancing POCUS proficiency to mitigate these limitations.
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Affiliation(s)
| | - Sarbjot Grewal
- Internal Medicine, Saint Agnes Medical Center, Fresno, USA
| | - Negin Nezarat
- Internal Medicine, Saint Agnes Medical Center, Fresno , USA
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11
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Nti BK, Kennedy S, Sarmiento E, Weinstein E, Russell F. Pediatric Emergency Medicine Faculty Response to Point-of-Care Ultrasound Credentialing Curriculum. Pediatr Emerg Care 2023; 39:e35-e40. [PMID: 36099540 DOI: 10.1097/pec.0000000000002843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES As point-of-care ultrasound (POCUS) continues to evolve in pediatric emergency medicine (PEM), new protocols and curricula are being developed to help establish the standards of practice and delineate training requirements. New suggested guidelines continue to improve, but a national standard curriculum for training and credentialing PEM providers is still lacking. To understand the barriers and perception of curriculum implementation for PEM providers, we created an ultrasound program at our institution and observed attitudes and response to training. METHODS Fourteen PEM-fellowship-trained faculty with limited to no previous experience with POCUS underwent training within a 12-month time frame using a modified practice-based training that included didactics, knowledge assessment, and hands-on practice. As part of the curriculum, the faculty completed a 3-phase survey before, after, and 6 months after completion of the curriculum. RESULTS There was a 100%, 78.6%, and 71.4% response rate for the presurvey, postsurvey, and 6 months postsurvey, respectively. Lack of confidence with using POCUS went from 100% on the presurvey to 57% on the postsurvey and down to 30% on the 6th month postsurvey. All other barriers also decreased from precurriculum to postcurriculum, except for length of time to perform POCUS. Participants rated the curriculum highly, with a mean Likert score and standard error of the mean at 3.9 ± 0.73, respectively. The average rating for whether POCUS changed clinical practice was low (2.6 ± 1.34). CONCLUSION These results show that a simplified structured curriculum can improve perception of POCUS and decrease barriers to usage while helping to understand obstacles for implementation of POCUS among PEM-fellowship-trained faculty.
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Affiliation(s)
| | - Sarah Kennedy
- Division of Clinical Ultrasound, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | | | - Elizabeth Weinstein
- From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Frances Russell
- Division of Clinical Ultrasound, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
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Ross DW, Moses AA, Niyyar VD. Point-of-care ultrasonography in nephrology comes of age. Clin Kidney J 2022; 15:2220-2227. [PMID: 36381376 PMCID: PMC9664573 DOI: 10.1093/ckj/sfac160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Indexed: 03/22/2024] Open
Abstract
The physical exam is changing. Many have argued that the physical exam of the 21st century should include point-of-care ultrasound (POCUS). POCUS is being taught in medical schools and has been endorsed by the major professional societies of internal medicine. In this review we describe the trend toward using POCUS in medicine and describe where the practicing nephrologist fits in. We discuss what a nephrologist's POCUS exam should entail and we give special attention to what nephrologists can gain from learning POCUS. We suggest a 'nephro-centric' approach that includes not only ultrasound of the kidney and bladder, but of the heart, lungs and vascular access. We conclude by reviewing some of the sparse data available to guide training initiatives and give suggested next steps for advancing POCUS in nephrology.
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Affiliation(s)
- Daniel W Ross
- Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Division of Kidney Diseases and Hypertension, Great Neck, NY, USA
| | - Andrew A Moses
- Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lenox Hill Division of Nephrology, New York, NY, USA
| | - Vandana Dua Niyyar
- Emory University, Division of Nephrology, Woodruff Memorial Research Building, Atlanta GA, USA
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Elsayed T, Snelling PJ, Stirling EJ, Watkins S. Emergency medicine trainees' perceived barriers to training and credentialing in point-of-care ultrasound: A cross-sectional study. Australas J Ultrasound Med 2022; 25:160-165. [PMID: 36405796 PMCID: PMC9644443 DOI: 10.1002/ajum.12317] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Point-of-care ultrasound (POCUS) is an important tool in emergency medicine (EM), with the Australasian College for Emergency Medicine (ACEM) recommending core modalities as part of fellowship training. In Australia, acquisition of these skills is certified via credentialing but is currently poorly undertaken by EM trainees. Methods We performed a cross-sectional survey of EM trainees across two academic teaching hospitals in Gold Coast, Queensland, between December 2018 and January 2019, to determine the current state of training and perceived barriers to credentialing in POCUS. Results Fifty-two (59%) eligible EM trainees participated. Although credentialing rates (15%) were low amongst respondents, the majority agreed that it was necessary (69%) and should form part of ACEM training (88%). Amongst these trainees, we identified the desire for increased POCUS training and several barriers including time constraints and the credentialing process itself. Conclusion Although there is general agreement amongst EM trainees for POCUS credentialing, barriers such as time limitations and technical difficulties were prohibitive for many. We propose the development of an internal structured POCUS training programme within mandatory training time to address these issues.
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Affiliation(s)
- Tarek Elsayed
- Emergency DepartmentGold Coast Hospital and Health ServiceSouthport4215QueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
- Faculty of Health Sciences & MedicineBond UniversityRobinaQueenslandAustralia
| | - Peter J. Snelling
- Emergency DepartmentGold Coast Hospital and Health ServiceSouthport4215QueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
- Faculty of Health Sciences & MedicineBond UniversityRobinaQueenslandAustralia
- Child Health Research CentreUniversity of QueenslandQueenslandAustralia
- Sonography Innovation and Research (Sonar) GroupGold CoastQueenslandAustralia
| | - Erin J. Stirling
- Emergency DepartmentGold Coast Hospital and Health ServiceSouthport4215QueenslandAustralia
| | - Stuart Watkins
- Emergency DepartmentGold Coast Hospital and Health ServiceSouthport4215QueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
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14
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Russ B, Arthur J, Lewis Z, Snead G. A REVIEW OF LAWSUITS RELATED TO POINT-OF-CARE EMERGENCY ULTRASOUND APPLICATIONS. J Emerg Med 2022; 63:661-672. [PMID: 35953324 DOI: 10.1016/j.jemermed.2022.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/22/2022] [Accepted: 04/23/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Previous investigators have assessed United States Case Law to evaluate the medicolegal risk surrounding point-of-care ultrasound applications. These studies have suggested that nonperformance is the primary source of an allegation of medical malpractice. OBJECTIVES The objective of this study is to update the literature regarding medical malpractice cases involving ultrasound applications that could be used at the point of care, and assess the risk conveyed to advanced practice providers and by application of emerging applications of ultrasound. METHODS Authors reviewed the Westlaw database for medical malpractice cases involving point-of-care ultrasound applications between December 2012 and January 2021. Cases were included if there was an allegation of misconduct by an emergency provider and if an ultrasound included in the American College of Emergency Physicians investigators core, extended, emerging, or adjunct applications was discussed to any degree. Investigators independently reviewed the cases for inclusion. Authors abstracted the case information, type of ultrasound performed, and the specific allegation of misconduct. RESULTS Nineteen cases met inclusion criteria. Seven cases involved core applications of emergency ultrasound and 13 involved extended, emerging, or adjunct applications. One case was included in both categories as it included elements of both core and extended applications. The most common primary allegation was failure to perform an ultrasound. No cases clearly alleged misinterpretation of a point-of-care ultrasound. CONCLUSION As previous studies have suggested, nonperformance of ultrasound seems to convey the greatest medicolegal risk. Extended, emerging, or adjunct applications of ultrasound may convey a slightly higher risk.
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Affiliation(s)
- Brian Russ
- Division of Emergency Ultrasound, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Jason Arthur
- Division of Emergency Ultrasound, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Zachary Lewis
- Division of Emergency Ultrasound, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Gregory Snead
- Division of Emergency Ultrasound, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Point-of-care ultrasound image archiving and quality improvement: not "If?" or "When?"…but "How?" and "What Next…?". CAN J EMERG MED 2022; 24:113-114. [PMID: 35258816 DOI: 10.1007/s43678-022-00281-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/08/2022] [Indexed: 11/02/2022]
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Shaddock L, Smith T. Potential for Use of Portable Ultrasound Devices in Rural and Remote Settings in Australia and Other Developed Countries: A Systematic Review. J Multidiscip Healthc 2022; 15:605-625. [PMID: 35378744 PMCID: PMC8976575 DOI: 10.2147/jmdh.s359084] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/17/2022] [Indexed: 02/02/2023] Open
Abstract
Introduction Objective Methods Results Conclusion
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Affiliation(s)
- Liam Shaddock
- Medical Radiation Science, School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Tony Smith
- The University of Newcastle Department of Rural Health & School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
- Correspondence: Tony Smith, The University of Newcastle Department of Rural Health, C/- 69A High Street, Taree, Newcastle, NSW, Australia, Tel +61 466 440 037, Email
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18
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Marini TJ, Weiss SL, Gupta A, Zhao YT, Baran TM, Garra B, Shafiq I, Oppenheimer DC, Egoavil MS, Ortega RL, Quinn RA, Kan J, Dozier AM, Tamayo L, Carlotto C, Castaneda B. Testing telediagnostic thyroid ultrasound in Peru: a new horizon in expanding access to imaging in rural and underserved areas. J Endocrinol Invest 2021; 44:2699-2708. [PMID: 33970434 PMCID: PMC8572222 DOI: 10.1007/s40618-021-01584-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/21/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE Thyroid ultrasound is a key tool in the evaluation of the thyroid, but billions of people around the world lack access to ultrasound imaging. In this study, we tested an asynchronous telediagnostic ultrasound system operated by individuals without prior ultrasound training which may be used to effectively evaluate the thyroid and improve access to imaging worldwide. METHODS The telediagnostic system in this study utilizes volume sweep imaging (VSI), an imaging technique in which the operator scans the target region with simple sweeps of the ultrasound probe based on external body landmarks. Sweeps are recorded and saved as video clips for later interpretation by an expert. Two operators without prior ultrasound experience underwent 8 h of training on the thyroid VSI protocol and the operation of the telemedicine platform. After training, the operators scanned patients at a health center in Lima. Telediagnostic examinations were sent to the United States for remote interpretation. Standard of care thyroid ultrasound was performed by an experienced radiologist at the time of VSI examination to serve as a reference standard. RESULTS Novice operators scanned 121 subjects with the thyroid VSI protocol. Of these exams, 88% were rated of excellent image quality showing complete or near complete thyroid visualization. There was 98.3% agreement on thyroid nodule presence between VSI teleultrasound and standard of care ultrasound (Cohen's kappa 0.91, P < 0.0001). VSI measured the thyroid size, on average, within 5 mm compared to standard of care. Readers of VSI were also able to effectively characterize thyroid nodules, and there was no significant difference in measurement of thyroid nodule size (P = 0.74) between VSI and standard of care. CONCLUSION Thyroid VSI telediagnostic ultrasound demonstrated both excellent visualization of the thyroid gland and agreement with standard of care thyroid ultrasound for nodules and thyroid size evaluation. This system could be deployed for evaluation of palpable thyroid abnormalities, nodule follow-up, and epidemiological studies to promote global health and improve the availability of diagnostic imaging in underserved communities.
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Affiliation(s)
- T J Marini
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - S L Weiss
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - A Gupta
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - Y T Zhao
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - T M Baran
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - B Garra
- Medical Imaging Ministries of the Americas, 10810 Lake Minneola Shores, Clermont, FL, 34711, USA
| | - I Shafiq
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - D C Oppenheimer
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - M S Egoavil
- Medical Innovation and Technology, Calle Los Libertadores 635, 15046, San Isidro, Peru
| | - R L Ortega
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - R A Quinn
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - J Kan
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - A M Dozier
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - L Tamayo
- Medical Innovation and Technology, Calle Los Libertadores 635, 15046, San Isidro, Peru
| | - C Carlotto
- Medical Innovation and Technology, Calle Los Libertadores 635, 15046, San Isidro, Peru
| | - B Castaneda
- Pontifica Universidad Catolica del Peru, Av. Universitaria 1801, 15088, San Miguel, Peru.
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19
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Manivel V, Kennedy-Smith E, Mirmiran B, Cormack CJ, Garner A, Condous G. Australasian emergency ultrasound: A survey on the current status. Emerg Med Australas 2021; 34:385-397. [PMID: 34850574 DOI: 10.1111/1742-6723.13904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/17/2021] [Accepted: 10/29/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Emergency ultrasound (EUS) has become an integral part of emergency medicine, and the core pillars of governance, infrastructure, administration, education and quality assurance (QA) are vital for its quality and continued growth. We aimed to assess the status of these vital pillars among Australasian EDs. METHODS A survey among the clinical leads in ultrasound (CLUS) in Australasian EDs from November 2020 to April 2021. RESULTS We analysed a total of 98 responses from CLUS representing 98 EDs. Most CLUS (85%) held EUS qualifications (CCPU 57%, DDU 18%, other 9%) but 15% had none. Only 66% of CLUS had dedicated clinical support time, and a mere 5% had administrative personnel support. Up to three ultrasound machines in 62% of EDs, but only 26% of EDs had secured image archiving facilities. In-house credentialing and the Australasian College for Emergency Medicine (ACEM) trainee special skills placement were available in 50% and 32% of EDs, respectively. Only 11% of EDs had regular EUS training for FACEMs, and only 66% of EDs had regular EUS education for emergency medicine trainees. Only 20 EDs had sonographer educators. Regarding EUS QA, only 33% of EDs provided formal EUS report, 23% of EDs conducted regular image reviews and 37% of EDs audited EUS performance. Only 35% of EDs had high-level disinfection equipment, and 56% of EDs had formal transducer disinfection protocols. CONCLUSION Despite ACEM recommendations for the practice of EUS, Australasian EDs still lack vital governance, administrative support, infrastructure, education and QA processes. Prompt actions such as ACEM mandating these recommendations are required to improve resource allocation by health services.
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Affiliation(s)
- Vijay Manivel
- Emergency Department, Nepean Hospital, Sydney, New South Wales, Australia.,Emergency Care, Sydney Adventist Hospital, Sydney, New South Wales, Australia.,Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Behzad Mirmiran
- Emergency Ultrasound, Nepean Hospital, Sydney, New South Wales, Australia
| | | | - Alan Garner
- Emergency Department, Nepean Hospital, Sydney, New South Wales, Australia.,Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - George Condous
- Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,OMNI Gynaecological Care, Sydney, New South Wales, Australia
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20
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Koratala A, Olaoye OA, Bhasin-Chhabra B, Kazory A. A Blueprint for an Integrated Point-of-Care Ultrasound Curriculum for Nephrology Trainees. KIDNEY360 2021; 2:1669-1676. [PMID: 35372975 PMCID: PMC8785780 DOI: 10.34067/kid.0005082021] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/13/2021] [Indexed: 02/04/2023]
Abstract
Point-of-care ultrasonography (POCUS) is a limited ultrasound study performed by the clinician at the bedside as a component or an adjunct to physical examination. POCUS has multiple applications in nephrology practice, including evaluation of obstructive uropathy, objective assessment of volume status, arteriovenous access assessment, and procedural guidance. However, unlike specialties such as emergency medicine, POCUS training is not yet integrated into most nephrology fellowship curricula, and the sonographic applications taught vary widely among fellowship programs. In this article, we have used our institutional experience to provide a roadmap or blueprint for nephrology programs looking to create a POCUS program. We provide an overview of the curriculum, including the basic organization, applications taught, online resources, milestone development, and quality assessment. We also discuss the nuances of POCUS workflow and perspectives on billing for these limited studies. In addition, we share the evaluation forms and sample documentation we use in our program. Future support, in the form of endorsed nephrology society guidelines, is needed before POCUS training is universally incorporated across nephrology fellowship programs.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Olanrewaju A. Olaoye
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, Florida
| | | | - Amir Kazory
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, Florida
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21
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Marini TJ, Oppenheimer DC, Baran TM, Rubens DJ, Dozier A, Garra B, Egoavil MS, Quinn RA, Kan J, Ortega RL, Zhao YT, Tamayo L, Carlotto C, Castaneda B. Testing telediagnostic right upper quadrant abdominal ultrasound in Peru: A new horizon in expanding access to imaging in rural and underserved areas. PLoS One 2021; 16:e0255919. [PMID: 34379679 PMCID: PMC8357175 DOI: 10.1371/journal.pone.0255919] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/26/2021] [Indexed: 01/11/2023] Open
Abstract
Background Hepatic and biliary diseases are prevalent worldwide, but the majority of people lack access to diagnostic medical imaging for their assessment. The liver and gallbladder are readily amenable to sonographic examination, and ultrasound is a portable, cost-effective imaging modality suitable for use in rural and underserved areas. However, the deployment of ultrasound in these settings is limited by the lack of experienced sonographers to perform the exam. In this study, we tested an asynchronous telediagnostic system for right upper quadrant abdominal ultrasound examination operated by individuals without prior ultrasound experience to facilitate deployment of ultrasound to rural and underserved areas. Methods The teleultrasound system utilized in this study employs volume sweep imaging and a telemedicine app installed on a tablet which connects to an ultrasound machine. Volume sweep imaging is an ultrasound technique in which an individual scans the target region utilizing preset ultrasound sweeps demarcated by easily recognized external body landmarks. The sweeps are saved as video clips for later interpretation by an experienced radiologist. Teleultrasound scans from a Peruvian clinic obtained by individuals without prior ultrasound experience were sent to the United States for remote interpretation and quality assessment. Standard of care comparison was made to a same-day ultrasound examination performed by a radiologist. Results Individuals without prior ultrasound experience scanned 144 subjects. Image quality was rated “poor” on 36.8% of exams, “acceptable” on 38.9% of exams, and “excellent” on 24.3% of exams. Among telemedicine exams of “acceptable” or “excellent” image quality (n = 91), greater than 80% of the liver and gallbladder were visualized in the majority of cases. In this group, there was 95% agreement between standard of care and teleultrasound on whether an exam was normal or abnormal, with a Cohen’s kappa of 0.84 (95% CI 0.7–0.98, p <0.0001). Finally, among these teleultrasound exams of “acceptable” or “excellent” image quality, the sensitivity for cholelithiasis was 93% (95% CI 68.1%-99.8%), and the specificity was 97% (95% CI 89.5%-99.6%). Conclusion This asynchronous telediagnostic system allows individuals without prior ultrasound experience to effectively scan the liver, gallbladder, and right kidney with a high degree of agreement with standard of care ultrasound. This system can be deployed to improve access to diagnostic imaging in low-resource areas.
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Affiliation(s)
- Thomas J. Marini
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Daniel C. Oppenheimer
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Timothy M. Baran
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Deborah J. Rubens
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Ann Dozier
- Department of Public Health, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Brian Garra
- Medical Imaging Ministries of the Americas, Clermont, Florida, United States of America
| | | | - Rosemary A. Quinn
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Jonah Kan
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Rafael L. Ortega
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Yu T. Zhao
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Lorena Tamayo
- Medical Innovation and Technology, San Isidro, Lima, Peru
| | | | - Benjamin Castaneda
- Department of Engineering, Pontifica Universidad Catolica del Peru, San Miguel, Lima, Peru
- * E-mail:
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22
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Koratala A, Reisinger N. POCUS for Nephrologists: Basic Principles and a General Approach. KIDNEY360 2021; 2:1660-1668. [PMID: 35372985 PMCID: PMC8785785 DOI: 10.34067/kid.0002482021] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/04/2021] [Indexed: 02/04/2023]
Abstract
Point-of-care ultrasonography (POCUS) has evolved as a valuable adjunct to physical examination in the recent past and various medical specialties have embraced it. However, POCUS training and scope of practice remain relatively undefined in nephrology. The utility of diagnostic POCUS beyond kidney and vascular access is under-recognized. Assessment of fluid status is a frequent dilemma faced by nephrologists in day-to-day practice where multiorgan POCUS can enhance the sensitivity of conventional physical examination. POCUS also reduces fragmentation of care, facilitates timely diagnosis, and expedites management. Although the need for further imaging studies is obviated in selected patients, POCUS is not meant to serve as an alternative to consultative imaging. In addition, the utility of POCUS depends on the skills and experience of the operator, which in turn depend on the quality of training. In this review, we discuss the rationale behind nephrologists performing POCUS, discuss patient examples to illustrate the basic principles of focused ultrasonography, and share our experience-based opinion about developing a POCUS training program at the institutional level.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nathaniel Reisinger
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, Pennsylvania
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23
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Parri N, Berant R, Giacalone M, Corsini I, Titomanlio L, Connolly J, Kwan C, Teng D. Point-of-care ultrasonography in pediatrics. Pediatr Radiol 2021; 51:1271-1272. [PMID: 33909085 DOI: 10.1007/s00247-021-05077-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/11/2021] [Accepted: 04/08/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Niccolò Parri
- Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, viale Gaetano Pieraccini, 24, 50139, Florence, Italy.
| | - Ron Berant
- Emergency Department, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Martina Giacalone
- Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, viale Gaetano Pieraccini, 24, 50139, Florence, Italy
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Luigi Titomanlio
- Pediatric Emergency Department, University of Paris, APHP Robert Debré Hospital, Paris, France
| | - Jim Connolly
- Great North Trauma and Emergency Care Centre, Newcastle, UK
| | - Charisse Kwan
- Division of Pediatric Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - David Teng
- Division of Pediatric Emergency Medicine, Cohen Children's Medical Center - Northwell Health, NY, USA
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24
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Koratala A, Kazory A. An Introduction to Point-of-Care Ultrasound: Laennec to Lichtenstein. Adv Chronic Kidney Dis 2021; 28:193-199. [PMID: 34906303 DOI: 10.1053/j.ackd.2021.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/26/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
Point-of-care ultrasonography (POCUS) is rapidly evolving as a noninvasive adjunct to physical examination among various specialties. POCUS increases the sensitivity of conventional physical examination by providing the answers to simple clinical questions at the bedside. As such, it can reduce fragmentation of care and expedite management. In addition, using bedside ultrasound as the first-line investigation may eliminate unnecessary radiation and contrast exposure. The advent of highly portable and affordable ultrasound devices has made the use of POCUS more practical and user-friendly, making it the stethoscope of the 21st century. This review will provide an overview of the rationale for integrating POCUS into nephrology practice. We also discuss the current scope of POCUS practice and state of training.
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25
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Dversdal RK, Northcutt NM, Ferre RM. Building and Maintaining an Ultrasound Program: It Takes a Village. Adv Chronic Kidney Dis 2021; 28:236-243. [PMID: 34906308 DOI: 10.1053/j.ackd.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/27/2021] [Accepted: 06/09/2021] [Indexed: 12/23/2022]
Abstract
Building and maintaining a successful point-of-care ultrasound program is a complex process that involves establishing an ecosystem between three unique but overlapping domains: ultrasound equipment, ultrasound users, and the health care system. By highlighting the different areas of focus and each of the key stakeholders and components, a group can ensure adequate attention is paid to all aspects of point-of-care ultrasound program development in nephrology.
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26
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Su E, Soni NJ, Blaivas M, Bhargava V, Steffen K, Haileselassie B. Regulating Critical Care Ultrasound, It Is All in the Interpretation. Pediatr Crit Care Med 2021; 22:e253-e258. [PMID: 33060421 DOI: 10.1097/pcc.0000000000002600] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Point-of-care ultrasound (POCUS) use is rapidly expanding as a practice in adult and pediatric critical care environments. In January 2020, the Joint Commission endorsed a statement from the Emergency Care Research Institute citing point-of-care ultrasound as a potential hazard to patients for reasons related to training and skill verification, oversight of use, and recordkeeping and accountability mechanisms for clinical use; however, no evidence was presented to support these concerns. Existing data on point-of-care ultrasound practices in pediatric critical care settings verify that point-of-care ultrasound use continues to increase, and contrary to the concerns raised, resources are becoming increasingly available for point-of-care ultrasound use. Many institutions have recognized a successful approach to addressing these concerns that can be achieved through multispecialty collaborations.
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Affiliation(s)
- Erik Su
- Department of Pediatrics, McGovern Medical School, Houston, TX
| | - Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX
- Department of Medicine, University of Texas Health San Antonio, San Antonio, TX
| | - Michael Blaivas
- Department of Emergency Medicine, School of Medicine, University of South Carolina, St. Francis Hospital, Columbus, GA
- Department of Medicine, School of Medicine, University of South Carolina, St. Francis Hospital, Columbus, GA
| | - Vidit Bhargava
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Katherine Steffen
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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Marini TJ, Rubens DJ, Zhao YT, Weis J, O’Connor TP, Novak WH, Kaproth-Joslin KA. Lung Ultrasound: The Essentials. Radiol Cardiothorac Imaging 2021; 3:e200564. [PMID: 33969313 PMCID: PMC8098095 DOI: 10.1148/ryct.2021200564] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/16/2021] [Accepted: 02/05/2021] [Indexed: 12/20/2022]
Abstract
Although US of the lungs is increasingly used clinically, diagnostic radiologists are not routinely trained in its use and interpretation. Lung US is a highly sensitive and specific modality that aids in the evaluation of the lungs for many different abnormalities, including pneumonia, pleural effusion, pulmonary edema, and pneumothorax. This review provides an overview of lung US to equip the diagnostic radiologist with knowledge needed to interpret this increasingly used modality. Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Thomas J. Marini
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
| | - Deborah J. Rubens
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
| | - Yu T. Zhao
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
| | - Justin Weis
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
| | - Timothy P. O’Connor
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
| | - William H. Novak
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
| | - Katherine A. Kaproth-Joslin
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
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Gopal M, O'Connor E, McDonald L, Goaman A, Radford A, Melling C, Henneyake S, Kumbhar V, Dagash H. Emergency scrotal exploration in children: Is it time for a change in mindset in the UK? J Pediatr Urol 2021; 17:190.e1-190.e7. [PMID: 33317943 DOI: 10.1016/j.jpurol.2020.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/18/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Acute scrotal pain is a common problem in children. Amongst the various causes, only testicular torsion (TT) needs urgent, and arguably any, surgical intervention. However TT accounts for only approximately 25% of cases. The diagnosis of TT is currently based mainly on history and clinical examination in the UK. OBJECTIVE We sought to find the incidence of finding TT during emergency scrotal exploration in four paediatric surgical centres in the UK. We also assessed the preoperative utilisation of clinical risk scores and Doppler ultrasound (DUS) to aid in the diagnosis. PATIENTS AND METHODS A retrospective review of 50 consecutive scrotal explorations done for acute scrotal pain at four tertiary pediatric surgical centres in 2019, including the preoperative utilisation of DUS, was analysed. Additionally an online survey was also sent out to consultant members of the British Association of Paediatric Urology to gauge their threshold for exploration, use of preoperative investigations and incidence of finding TT in their practice. RESULTS In the four UK centres reviewed, TT was found in 24.5% (SD = 8.54) of explorations. The overall utilisation of preoperative DUS was 10%. The online survey revealed a low threshold for exploration. However 72% of respondents recalled finding TT in <50% of explorations, with just over a third reporting finding TT in only 10% of explorations. There was low utilisation of preoperative DUS and clinical risk scores. DISCUSSION The incidence of finding TT during exploration in this cohort is the same as the incidence of TT in a population of children presenting with acute scrotal pain. We hypothesise that this is due to low accuracy of clinical assessment, low utilisation of preoperative clinical and radiological aids and the practice of exploring torted testicular appendages. Improving awareness and training in these modalities will increase diagnostic accuracy, limiting emergency scrotal explorations to those children with a higher risk of testicular torsion. A care pathway for children presenting with acute scrotal pain is suggested () CONCLUSIONS: There is a low incidence of finding testicular torsion during paediatric scrotal explorations in the UK. There is low preoperative utilisation of clinical risk scores and Doppler ultrasound, which if utilised, could improve diagnostic accuracy.
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Affiliation(s)
- Milan Gopal
- Great North Children's Hospital, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, UK.
| | - Elizabeth O'Connor
- Great North Children's Hospital, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, UK
| | - Leigh McDonald
- Great North Children's Hospital, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, UK
| | - Amy Goaman
- Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - Anna Radford
- Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - Charlotte Melling
- Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Supul Henneyake
- Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Vikrant Kumbhar
- Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK
| | - Haitham Dagash
- Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK
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Wong KE, Parikh PD, Miller KC, Zonfrillo MR. Emergency Department and Urgent Care Medical Malpractice Claims 2001-15. West J Emerg Med 2021; 22:333-338. [PMID: 33856320 PMCID: PMC7972370 DOI: 10.5811/westjem.2020.9.48845] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/11/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction This study reviews malpractice, also called medical professional liability (MPL), claims involving adult patients cared for in emergency departments (ED) and urgent care settings. Methods We conducted a retrospective review of closed MPL claims of adults over 18 years, from the Medical Professional Liability Association’s Data Sharing Project database from 2001–2015, identifying 6,779 closed claims. Data included the total amount, origin, top medical specialties named, chief medical factors, top medical conditions, severity of injury, resolution, average indemnity, and defense costs of closed claims. Results Of 6,779 closed claims, 65.9% were dropped, withdrawn, or dismissed. Another 22.8% of claims settled for an average indemnity of $297,709. Of the 515 (7.6%) cases that went to trial, juries returned verdicts for the defendant in 92.6% of cases (477/515). The remaining 7.4% of cases (38/515) were jury verdicts for the plaintiff, with an average indemnity of $816,909. The most common resulting medical condition cited in paid claims was cardiac or cardiorespiratory arrest (10.4%). Error in diagnosis was the most common chief medical error cited in closed claims. Death was the most common level of severity listed in closed (38.5%) and paid (42.8%) claims. Claims reporting major permanent injury had the highest paid-to-closed ratio, and those reporting grave injury had the highest average indemnity of $686,239. Conclusion This retrospective review updates the body of knowledge surrounding medical professional liability and represents the most recent analysis of claims in emergency medicine. As the majority of emergency providers will be named in a MPL claim during their career, it is essential to have a better understanding of the most common factors resulting in MPL claims.
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Affiliation(s)
- Kelly E Wong
- Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island
| | - P Divya Parikh
- Medical Professional Liability Association, Department of Research and Education, Rockville, Maryland
| | - Kwon C Miller
- Medical Professional Liability Association, Department of Research Database Management, Rockville, Maryland
| | - Mark R Zonfrillo
- Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,Alpert Medical School of Brown University, Departments of Emergency Medicine and Pediatrics, Providence, Rhode Island
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Kruser JM, Schmidt GA, Kory PD. COUNTERPOINT: Should the Use of Diagnostic Point-of-Care Ultrasound in Patient Care Require Hospital Privileging/Credentialing? No. Chest 2020; 157:498-500. [PMID: 32145806 DOI: 10.1016/j.chest.2019.10.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/12/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jacqueline M Kruser
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Gregory A Schmidt
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Pierre D Kory
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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31
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Legal issues in Neonatologist Performed Echocardiography. The Italian experience. Pediatr Res 2020; 87:1140-1142. [PMID: 31837650 DOI: 10.1038/s41390-019-0721-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 11/21/2019] [Indexed: 11/08/2022]
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Reaume M, Farishta M, Costello JA, Gibb T, Melgar TA. Analysis of lawsuits related to diagnostic errors from point-of-care ultrasound in internal medicine, paediatrics, family medicine and critical care in the USA. Postgrad Med J 2020; 97:55-58. [PMID: 32457206 DOI: 10.1136/postgradmedj-2020-137832] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study is to identify the extent of diagnostic error lawsuits related to point-of-care ultrasound (POCUS) in internal medicine, paediatrics, family medicine and critical care, of which little is known. METHODS We conducted a retrospective review of the Westlaw legal database for indexed state and federal lawsuits involving the diagnostic use of POCUS in internal medicine, paediatrics, family medicine and critical care. Retrieved cases were reviewed independently by three physicians to identify cases relevant to our study objective. A lawyer secondarily reviewed any cases with discrepancies between the three reviewers. RESULTS Our search criteria returned 131 total cases. Ultrasound was mentioned in relation to the lawsuit claim in 70 of the cases returned. In these cases, the majority were formal ultrasounds performed and reviewed by the radiology department, echocardiography studies performed by cardiologists or obstetrical ultrasounds. There were no cases of internal medicine, paediatrics, family medicine or critical care physicians being subjected to adverse legal action for their diagnostic use of POCUS. CONCLUSION Our results suggest that concerns regarding the potential for lawsuits related to POCUS in the fields of internal medicine, paediatrics, family medicine and critical care are not substantiated by indexed state and federal filed lawsuits.
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Affiliation(s)
- Michael Reaume
- Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mehdi Farishta
- Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Joseph A Costello
- Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Tyler Gibb
- Department of Medical Ethics-Humanities and Law, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Thomas A Melgar
- Pediatrics, Adolescent and Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
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Wyman MF, Yocum MD, Schnobrich DJ. Fulfilling the Potential of Point-of-Care Ultrasound in Hospital Medicine. J Hosp Med 2020; 15:190-191. [PMID: 32155409 DOI: 10.12788/jhm.3384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/13/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Molly F Wyman
- Divisions of General Internal Medicine and Hospital Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Matthew D Yocum
- Divisions of General Internal Medicine and Hospital Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Daniel J Schnobrich
- Divisions of General Internal Medicine and Hospital Pediatrics, University of Minnesota, Minneapolis, Minnesota
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Arystan AZ, Khamzina YT, Benberin VV, Fettser DV, Belenkov YN. [Lung Ultrasound: new Opportunities for a Cardiologist]. KARDIOLOGIIA 2020; 60:81-92. [PMID: 32245358 DOI: 10.18087/cardio.2020.1.n617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/13/2019] [Accepted: 09/17/2019] [Indexed: 06/11/2023]
Abstract
This review focused on ultrasound examination of lungs, a useful complement to transthoracic echocardiography (EchoCG), which is superior to chest X-ray in the diagnostic value. The lung acoustic window always remains open and allows obtaining high-quality images in most cases. For a cardiologist, the major points of the method application are determination of pleural effusion and lung congestion. This method has a number of advantages: it is time-saving; cost-effective; portable and accessible; can be used in a real-time mode; not associated with radiation; reproducible; and highly informative. The ultrasound finding of wet lungs would indicate threatening, acute cardiac decompensation long before appearance of clinical, auscultative, and radiological signs of lung congestion. Modern EchoCG should include examination of the heart and lungs as a part of a single, integrative ultrasound examination.
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Affiliation(s)
- A Z Arystan
- Medical Centre Hospital of the President's Affairs Administration of the Republic of Kazakhstan
| | - Y T Khamzina
- Medical Centre Hospital of the President's Affairs Administration of the Republic of Kazakhstan
| | - V V Benberin
- Medical Centre Hospital of the President's Affairs Administration of the Republic of Kazakhstan
| | - D V Fettser
- Municipal Clinical Hospital #52 at the Health Care Department of Moscow City
| | - Y N Belenkov
- I.M. Sechenov First Moscow State Medical University
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Olszynski P, Kim D, Liu R, Arntfield R. A Multidisciplinary Response to the Canadian Association of Radiologists' Point-of-Care Ultrasound Position Statement. Can Assoc Radiol J 2020; 71:136-137. [PMID: 32063015 DOI: 10.1177/0846537119898004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Paul Olszynski
- CAEP Emergency Ultrasound Committee, Emergency Medicine, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Daniel Kim
- Emergency Medicine, University of British Columbia, Vancouver, British Colombia, Canada
| | - Rachel Liu
- Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Robert Arntfield
- Critical Care Medicine, Western University, London, Ontario, Canada
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Wong A, Vieillard-Baron A, Malbrain ML. Emergency bedside ultrasound: benefits as well as caution – part 1. General. Curr Opin Crit Care 2019; 25:613-621. [DOI: 10.1097/mcc.0000000000000678] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose of review
The use of bedside or point-of-care ultrasound (POCUS) in medical emergencies is rapidly becoming more established as an effective acute diagnostic tool. The purpose of this review is to provide an overview of the various techniques currently used that are readily available, as well as several in development. Possible caveats are also addressed.
Recent findings
Despite its widespread use, definitive studies demonstrating improved patient outcomes are limited. The list of indications for POCUS nonetheless is increasing as practitioners acknowledge clinical benefits, and technological advancement improves diagnostic accuracy and efficiency of use.
Summary
We believe that a core level of POCUS should be achievable by practicing clinicians. Ultimately, the integration of POCUS findings into a patient management strategy must be holistic, and hence requires prudent consideration of the clinical scenario.
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Affiliation(s)
- Adrian Wong
- Department of Anaesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Guildford, UK
| | - Antoine Vieillard-Baron
- University Hospital Ambroise Paré, CESP, U1018, Université Versailles Saint Quentin en Yvelines, Versailles, France
| | - Manu L.N.G. Malbrain
- Department Intensive Care Medicine, University Hospital Brussel (UZB), Jette
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Picano E, Scali MC, Ciampi Q, Lichtenstein D. Lung Ultrasound for the Cardiologist. JACC Cardiovasc Imaging 2019; 11:1692-1705. [PMID: 30409330 DOI: 10.1016/j.jcmg.2018.06.023] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/25/2018] [Accepted: 06/19/2018] [Indexed: 02/06/2023]
Abstract
For a cardiologist, lung ultrasound is an add-on to transthoracic echocardiography, just as lung auscultation is part of a cardiac physical examination. A cardiac 3.5- to 5.0-MHz transducer is generally suitable because the small footprint makes it ideal for scanning intercostal spaces. The image quality is often adequate, and the lung acoustic window is always patent. The cumulative increase in imaging time is <1 min for the 2 main applications targeted on pleural water (pleural effusion) and lung water (pulmonary congestion as multiple B-lines). In these settings, lung ultrasound outperforms the diagnostic accuracy of the chest radiograph, with a low-cost, portable, real-time, radiation-free method. A "wet lung" detected by lung ultrasound predicts impending acute heart failure decompensation and may trigger lung decongestion therapy. The doctors of tomorrow may still listen with a stethoscope to their patient's lung, but they will certainly be seeing it with ultrasound.
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Affiliation(s)
| | | | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Daniel Lichtenstein
- Medical Intensive Care Unit, Ambroise-Paré Hospital, Paris-West University, Boulogne, France
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Conlon TW, Nishisaki A, Singh Y, Bhombal S, De Luca D, Kessler DO, Su ER, Chen AE, Fraga MV. Moving Beyond the Stethoscope: Diagnostic Point-of-Care Ultrasound in Pediatric Practice. Pediatrics 2019; 144:peds.2019-1402. [PMID: 31481415 DOI: 10.1542/peds.2019-1402] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 11/24/2022] Open
Abstract
Diagnostic point-of-care ultrasound (POCUS) is a growing field across all disciplines of pediatric practice. Machine accessibility and portability will only continue to grow, thus increasing exposure to this technology for both providers and patients. Individuals seeking training in POCUS should first identify their scope of practice to determine appropriate applications within their clinical setting, a few of which are discussed within this article. Efforts to build standardized POCUS infrastructure within specialties and institutions are ongoing with the goal of improving patient care and outcomes.
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Affiliation(s)
- Thomas W Conlon
- Departments of Anesthesiology and Critical Care Medicine and
| | - Akira Nishisaki
- Departments of Anesthesiology and Critical Care Medicine and
| | - Yogen Singh
- Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Shazia Bhombal
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Hopital Antoine Béclère, University Hospitals of South Paris, AP-HP, Paris, France.,Physiopathology and Therapeutic Innovation Unit, Inserm U999, Université Paris-Saclay, Paris, France; and
| | - David O Kessler
- Department of Emergency Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Erik R Su
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Aaron E Chen
- Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - María V Fraga
- Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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To See or Not to See… Is There Still a Question? Pediatr Crit Care Med 2019; 20:891-893. [PMID: 31483382 DOI: 10.1097/pcc.0000000000002041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Patel R, Rynecki N, Eidelman E, Maddukuri S, Ayyaswami V, Patel M, Gupta R, Prabhu AV, Magnani J. A Qualitative Analysis of Malpractice Litigation in Cardiology Using Case Summaries Through a National Legal Database Analysis. Cureus 2019; 11:e5259. [PMID: 31572644 PMCID: PMC6760876 DOI: 10.7759/cureus.5259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/28/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction Physicians are increasingly practicing defensive medicine as a response to society's litigious climate. This study sought to characterize cardiology malpractice claims and elucidate the allegations underlying the use of defensive medicine. Methods The WestlawNext™ database was queried to obtain state and federal jury verdicts and settlements related to medical malpractice and cardiology that occurred in the United States between 2010 and 2015. Cardiology cases were identified using the search terms "medical malpractice" and "cardiology" and reviewed by two individuals utilizing available case documents. Duplicate and nonpertinent cases were excluded. Binary logistic regression models were created to predict the likelihood of defendant verdict, plaintiff verdict, and settlement based on the various reasons for litigation cited. Results Inclusion criteria were met in 166 cases. The plaintiffs were predominantly male (94 cases; 56.6%), and the average patient age was 53.3±17.5 years. More than half of the cases involved a cardiologist as a defendant. The most common reasons for litigation were: failure to treat (129; 77.7%), failure to diagnose (115; 69.3%), failure to refer/order diagnostic tests (107; 64.5%), and patient death (118; 71.1%). Among cases tried for failure to diagnose, the most commonly missed diagnosis was myocardial infarction. Cases most commonly resulted in a defendant verdict (94; 56.6%). However, odds of a plaintiff verdict were significantly higher when failure to diagnose was alleged with an odds ratio (OR) of 7.60 (95% confidence interval 1.14 - 50.87, p = 0.0365). Conclusions Failure to diagnose remains a commonly alleged base for litigation. In conclusion, our analysis suggests increased training for non-cardiologists in the recognition of the acute coronary syndrome and enhanced awareness of inherent biases among all physicians may facilitate reducing missed diagnoses.
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Affiliation(s)
- Richa Patel
- Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Nicole Rynecki
- Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Eric Eidelman
- Medicine, University of Maryland School of Medicine, Baltimore, USA
| | | | - Varun Ayyaswami
- Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Manthan Patel
- Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | - Raghav Gupta
- Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Arpan V Prabhu
- Radiation Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Jared Magnani
- Cardiology, University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, USA
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Luong CL, Ong K, Kaila K, Pellikka PA, Gin K, Tsang TSM. Focused Cardiac Ultrasonography: Current Applications and Future Directions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:865-876. [PMID: 30146784 DOI: 10.1002/jum.14773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 06/08/2023]
Abstract
Focused cardiac ultrasonography is performed by clinicians at the bedside and is used in time-sensitive scenarios to evaluate a patient's cardiovascular status when comprehensive echocardiography is not immediately available. This simplified cardiac ultrasonography is often performed by noncardiologists using small, portable devices to augment the physical examination, triage patients, and direct management in both critical care and outpatient settings. However, as the use of focused cardiac ultrasonography continues to expand, careful consideration is required regarding training, scope of practice, impact on patient outcomes, and medicolegal implications. In this review, we examine some of the challenges with rapid uptake of this technique and explore the benefits and potential risk of focused cardiac ultrasonography. We propose possible mechanisms for cross-specialty collaboration, quality improvement, and oversight.
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Affiliation(s)
- Christina L Luong
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Ong
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kendeep Kaila
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patricia A Pellikka
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Kenneth Gin
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa S M Tsang
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Cichos KH, Ewing MA, Sheppard ED, Fuchs C, McGwin G, McMurtrie JT, Watson SL, Xu S, Fryberger C, Baker DK, Crabtree RM, Murphy AB, Vaughan LO, Perez JL, Sherrod BA, Edmonds BW, Ponce BA. Trends and Risk Factors in Orthopedic Lawsuits: Analysis of a National Legal Database. Orthopedics 2019; 42:e260-e267. [PMID: 30763449 DOI: 10.3928/01477447-20190211-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 09/10/2018] [Indexed: 02/03/2023]
Abstract
Orthopedic surgeons frequently encounter medical malpractice claims. The purpose of this study was to assess trends and risk factors in lawsuits brought against orthopedic surgeons using a national legal database. A legal research service was used to search publicly available settlement and verdict reports between 1988 and 2013 by terms "orthopaedic or orthopedic" and "malpractice." Temporal trends were evaluated, and logistic regression was used to identify independent risk factors for case outcomes. A total of 1562 publicly reported malpractice cases brought against orthopedic surgeons, proceeding to trial during a 26-year period, were analyzed. The plaintiffs won 462 (30%) cases, with a mean award of $1.4 million. The frequency of litigation and pay-outs for plaintiffs increased 215% and 280%, respectively, between the first and last 5-year periods. The mean payout for plaintiff-favorable verdicts was highest in pediatrics ($2.6 million), followed by spine ($1.7 million) and oncology ($1.6 million). Fracture fixation (363 cases), arthroplasty (290 cases), and spine (231 cases) were the most commonly litigated procedures, while plaintiffs were most successful for fasciotomy (48%), infection-treating procedures (43%), and carpal tunnel release (37%). When analyzing data by state and region, adjusted for population, northeastern states had a higher frequency of lawsuits. Malpractice liability has increased during the past 3 decades while orthopedic surgeons continue to win most of the cases making it to court. As patients search for medical care via publicly available information, it is important for orthopedic surgeons to understand what aspects of their own practice carry different risks of litigation. [Orthopedics. 2019; 42(2):e260-e267.].
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Phillips L, Hiew M. Point of care ultrasound: Breaking the sound barrier in the emergency department. Australas J Ultrasound Med 2019; 22:3-5. [PMID: 34760529 PMCID: PMC8411775 DOI: 10.1002/ajum.12129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Luke Phillips
- Emergency & Trauma CentreThe Alfred HospitalCommercial RoadMelbourneVictoria3004Australia
- Emergency Medicine Ultrasound Group (EMUGs)Virtual OfficeMelbourneVictoria3000Australia
| | - Melody Hiew
- Emergency Medicine Ultrasound Group (EMUGs)Virtual OfficeMelbourneVictoria3000Australia
- Emergency DepartmentCasey HospitalMonash Health62‐70 Kangan DriveBerwickVictoria3806Australia
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Moussa M, Stausmire JM. Do emergency physicians rely on point-of-care ultrasound for clinical decision making without additional confirmatory testing? JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:437-441. [PMID: 29740831 DOI: 10.1002/jcu.22604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 03/21/2018] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE It is unknown if Emergency Physicians (EPs) rely solely on Emergency Medicine performed Point-Of-Care Ultrasound (EM-POCUS) for clinical decision making or if they proceed to subsequent "gold standard" studies for confirmatory diagnosis. METHODS After Institutional Review Board approval, an online survey was distributed by the Ohio Chapter of the American College of Emergency Physicians to its members. RESULTS The most common EM-POCUS procedures used without confirmatory testing were: determination of cardiac activity during cardiac arrest (81.3%), differentiating cellulitis from abscess (63.2%), central venous catheter placement confirmation (43.2%), pericardial effusion evaluation (41.9%) and focused assessment with sonography for trauma (FAST-37.4%). The responses regarding remaining procedures suggest most physicians do not use EM-POCUS or verify EM-POCUS findings with additional testing. One hundred fifty-five survey responses provided a confidence interval of >90%. Two-thirds (67.7%) of respondents were board-certified EPs with 43.8% in practice for less than 5 years. EM-POCUS examinations were performed at least weekly by 37.4% of respondents; 28.4% performed at least 1 EM-POCUS examination per shift. Nearly half (47.7%) responded they had no concerns regarding use of EM-POCUS. CONCLUSIONS This study describes the results of a survey on the use of EM-POCUS for clinical decision making by Ohio EPs. A majority of them continues to rely on gold standard testing for confirmatory diagnosis, in addition to EM-POCUS.
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Affiliation(s)
- Mohamad Moussa
- University of Toledo Medical Center Emergency Medicine, Dowling Hall 2455 Mail Stop 1088, 3000 Arlington Ave., Toledo, Ohio 43614
| | - Julie M Stausmire
- Mercy Health St. Vincent Medical Center, Regional Academic Affairs/Research, 2222 Cherry St, MOB-2, Suite 1300, Toledo, Ohio 43608
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Steinemann S, Fernandez M. Variation in training and use of the focused assessment with sonography in trauma (FAST). Am J Surg 2017; 215:255-258. [PMID: 29174769 DOI: 10.1016/j.amjsurg.2017.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 10/06/2017] [Accepted: 11/04/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Training in ultrasound is variable among residents and practicing traumatologists. Focused Assessment with Sonography in Trauma (FAST) may be underused in non-urbanized areas, possibly due to lack of training. METHODS State trauma registry data from January 2014-June 2016 were reviewed for FAST results. Trauma practitioners were surveyed querying training, confidence, and obstacles to performing FAST. RESULTS 12,855 records revealed highest FAST use at the urban Level II center (39%, p < 0.0001). Despite similar injury patterns, non-urban/Level III centers' frequency of FAST was only 1-28%. 39 practitioners were surveyed, those with training (54%) were more likely to use FAST (p < 0.05). 61% of practitioners outside the Level II center cited lack of confidence in their ability to perform FAST as the primary reason for omitting the exam. CONCLUSIONS FAST is relatively underused in non-urbanized areas of the state. Lack of confidence in ability to perform FAST was cited as the primary barrier.
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Affiliation(s)
- Susan Steinemann
- University of Hawaii, Department of Surgery, Honolulu, HI, USA; The Queen's Medical Center, Honolulu, HI, USA.
| | - Mayumi Fernandez
- University of Hawaii, Department of Surgery, Honolulu, HI, USA; The Queen's Medical Center, Honolulu, HI, USA.
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Desy JR, Ma IWY. In defence of teaching point-of-care ultrasound in undergraduate medical education. MEDICAL EDUCATION 2017; 51:1087. [PMID: 28901649 DOI: 10.1111/medu.13363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Janeve R Desy
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Irene W Y Ma
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Affiliation(s)
- Nilam J Soni
- Division of General & Hospital Medicine, The University of Texas School of Medicine at San Antonio, San Antonio, Texas, USA.
- Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - David M Tierney
- Abbott Northwestern Hospital, Department of Medical Education, Minneapolis, Minnesota, USA
| | - Trevor P Jensen
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Brian P Lucas
- Medicine Service, White River Junction VA Medical Center, White River Junction, Vermont, USA
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
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Snelling PJ, Tessaro M. Paediatric emergency medicine point-of-care ultrasound: Fundamental or fad? Emerg Med Australas 2017; 29:486-489. [PMID: 28845599 DOI: 10.1111/1742-6723.12848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Peter J Snelling
- Emergency Department, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Department of Paediatrics, Greenslopes Private Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Mark Tessaro
- Emergency Department, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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