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Ultrasound article
Improved diagnostic accuracy of pathology with the implementation of a perioperative point-of-care ultrasound service: quality improvement initiative
  1. Davinder Ramsingh,
  2. Alec Runyon,
  3. Jason Gatling,
  4. Ihab Dorotta,
  5. Ryan Lauer,
  6. Dustin Wailes,
  7. Jaron Yang,
  8. Matt Alschuler,
  9. Briahnna Austin,
  10. Gary Stier and
  11. Robert Martin
  1. Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA
  1. Correspondence to Dr Davinder Ramsingh, Loma Linda University Medical Center, Loma Linda, CA 92354, USA; dramsingh{at}llu.edu

Abstract

Introduction The utility of perioperative point-of-care ultrasound (P-POCUS) is rapidly growing. The successful implementation of a comprehensive P-POCUS curriculum, Focused PeriOperative Risk Evaluation Sonography Involving Gastro-abdominal, Hemodynamic, and Trans-thoracic Ultrasound (FORESIGHT), has been demonstrated. This project sought to further evaluate the utility of P-POCUS with the following aims: (1) to assess the ability to train the FORESIGHT curriculum via a free, open-access, online platform; (2) to launch a P-POCUS clinical service as a quality improvement (QI) initiative; (3) to evaluate the diagnostic accuracy of the P-POCUS examinations to formal diagnostic studies; and (4) to compare the P-POCUS diagnostic accuracy with the diagnostic accuracy of traditional assessment (TA).

Methods This study was launched as a QI project for the implementation of a P-POCUS service. A group of attending and resident anesthesiologists completed P-POCUS training supported by an online curriculum. After training, a P-POCUS service was launched. The P-POCUS service was available for any perioperative event, and specific triggers were also identified. All examinations were documented on a validated datasheet. The diagnostic accuracy of the two index tests, P-POCUS and TA, were compared with formal diagnostic testing. TA was defined as a combination of the anesthesiologist’s bedside assessment and physical examination. The primary outcome marker was a comparison in the accuracy of new diagnosis detected by P-POCUS service versus the TA performed by the primary anesthesiologist.

Results A total of 686 P-POCUS examinations were performed with 466 examinations having formal diagnostic studies for comparison. Of these, 92 examinations were detected as having new diagnoses. Performance for detection of a new diagnosis demonstrated a statistically higher sensitivity for the P-POCUS examinations (p<0.0001). Performance comparison of all P-POCUS examinations that were matched to formal diagnostic studies (n=466) also demonstrated a significantly higher sensitivity. These findings were consistent across cardiovascular, pulmonary and abdominal P-POCUS categories (p<0.01). Additionally, multiple pathologies demonstrated complete agreement between the P-POCUS examination and the formal study.

Conclusion A P-POCUS service can be developed after training facilitated by an online curriculum. P-POCUS examinations can be performed by anesthesiologists with a high degree of accuracy to formal studies, which is superior to TA.

  • point-of-care ultrasound
  • perioperative medicine
  • bedside assessment
  • online ultrasound education
  • quality improvement
  • diagnostic accuracy of point of care ultrasound

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, an indication of whether changes were made, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/rapm-2019-100632

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    Footnotes

    • Contributors All authors have reviewed this manuscript and have contributed as described. DR, RL, ID, JG and RM contributed to the concept design. BA, DR and AR contributed to the statistical analysis. DR, AR, JG, ID, RL, DW, JY, MA and GS contributed to the data collection. DR and RM did the planning. DR, JG, RL, ID, GS and RM contributed to the administrative requirements. DR, AR, JG, ID, RL, DW, JY, MA, BA, GS and RM contributed to the critical review of the manuscript. DR, AR and BA contributed to the interpretation of data. DR and BA drafted the tables and figures. DR, AR and BA drafted the manuscript.

    • Funding This project was partially supported by General Electric Healthcare (Fairfield, Connecticut, USA) as an investigator-initiated sponsored project.

    • Competing interests DR has recieved funded research from General Electric on point-of-care ultrasound and is a consultant for Fujifilm Sonosite

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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