重症监护病房护理点超声诊断项目的发展和影响。

IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pediatric Critical Care Medicine Pub Date : 2024-11-01 Epub Date: 2024-07-18 DOI:10.1097/PCC.0000000000003581
David R Baker, Christie L Glau, Adam S Himebauch, Sara Arnoldi, Sam Rosenblatt, Garrett Keim, Steven M Loscalzo, Mark D Weber, Meryl Cohen, Michael D Quartermain, Summer L Kaplan, Robert M Sutton, Akira Nishisaki, Thomas W Conlon
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引用次数: 0

摘要

目的评估床旁超声波(POCUS)的使用对 PICU 临床医生的影响,并评估 POCUS 项目发展的基础设施要素:设计:回顾性观察研究:环境:美国大型非心脏病学术性 PICU:干预措施:无:测量和主要结果2017年1月1日至2022年12月31日期间,共进行了7201例诊断性POCUS检查;其中1930例(26.8%)在独立的POCUS QA数据库中生成了质量保证(QA)记录。心脏领域的成像最为频繁(81.0% 的订购研究,81.2% 的审查研究)。在 1930 例病例中,有 563 例(29.2%)的 POCUS 图像改变了临床医生对病理生理学的理解;在 563 例病例中,有 318 例(56.5%)的 POCUS 图像改变了治疗方法。在 30.1% 的病例(472/1568 例)中,心脏 POCUS 研究改变了临床医生怀疑的病理生理学,而在非心脏研究中,这一比例为 21.5%(91/362 例)(p = 0.06)。在 POCUS 改变了临床医生认识的病例中,心脏科 POCUS 比非心脏科 POCUS 更常改变处理方法(p = 0.02)。在 1568 次心脏 POCUS 检查中,有 294 次(18.8%)临床医生发现需要心脏科会诊或完整的超声心动图检查。从最初研究年到最后研究年,POCUS 成像订单增加了 94.9%,收入增加了 159.4%。临床医生和审查人员对质量保证数据库的使用逐年减少,因为质量保证流程是在技术发展和单位扩张的背景下演变而来的:结论:PICU 的 POCUS 成像诊断经常会产生改变诊断和管理的信息。随着 PICU POCUS 使用量的增加,质量保证流程也在不断发展,导致我们最初的质量保证数据库使用量减少。随着临床环境的不断变化,有必要对质量保证流程进行修改。
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Evolution and Impact of a Diagnostic Point-of-Care Ultrasound Program in a PICU.

Objectives: To evaluate the impact of point-of-care ultrasound (POCUS) use on clinicians within a PICU and to assess infrastructural elements of our POCUS program development.

Design: Retrospective observational study.

Setting: Large academic, noncardiac PICU in the United States.

Subjects: Patients in a PICU who had diagnostic POCUS performed.

Interventions: None.

Measurements and main results: Between January 1, 2017, and December 31, 2022, 7201 diagnostic POCUS studies were ordered; 1930 (26.8%) had a quality assurance (QA) record generated in an independent POCUS QA database. The cardiac domain was most frequently imaged (81.0% of ordered studies, 81.2% of reviewed studies). POCUS images changed clinician understanding of pathophysiology in 563 of 1930 cases (29.2%); when this occurred, management was changed in 318 of 563 cases (56.5%). Cardiac POCUS studies altered clinician suspected pathophysiology in 30.1% of cases (472/1568), compared with 21.5% (91/362) in noncardiac studies ( p = 0.06). Among cases where POCUS changed clinician understanding, management changed more often following cardiac than noncardiac POCUS ( p = 0.02). Clinicians identified a need for cardiology consultation or complete echocardiograms in 294 of 1568 cardiac POCUS studies (18.8%). Orders for POCUS imaging increased by 94.9%, and revenue increased by 159.4%, from initial to final study year. QA database use by both clinicians and reviewers decreased annually as QA processes evolved in the setting of technologic growth and unit expansion.

Conclusions: Diagnostic POCUS imaging in the PICU frequently yields information that alters diagnosis and changes management. As PICU POCUS use increased, QA processes evolved resulting in decreased use of our initial QA database. Modifications to QA processes are likely necessary as clinical contexts change over time.

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来源期刊
Pediatric Critical Care Medicine
Pediatric Critical Care Medicine 医学-危重病医学
CiteScore
7.40
自引率
14.60%
发文量
991
审稿时长
3-8 weeks
期刊介绍: Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
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