Point of Care Ultrasound with Dr. Thomas Conlon and Dr. Sarah Ginsburg--Part 2
Apr 15, 2024
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Dr. Thomas Conlon and Dr. Sarah Ginsburg discuss the importance of Point of Care Ultrasound in pediatric ICU, addressing challenges in program implementation and competency assessments. They emphasize collaboration with specialists for quality assurance and continuous training to enhance ultrasound practice.
37:32
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Quick takeaways
Pediatric critical care units need sustained infrastructure and support for successful Point of Care Ultrasound integration.
Robust quality assurance and documentation processes are essential for minimizing medical-legal risks associated with POCUS.
Deep dives
Current State of Point of Care Ultrasound Use in Pediatric ICUs
About two-thirds of pediatric intensivists have some training in clinical use of Point of Care Ultrasound (POCUS), but many lack essential program components like credentialing and quality assurance. Pediatric critical care units are still working on incorporating POCUS fully, unlike adult emergency departments that have been quicker to adopt it. Sustained infrastructure and support systems are crucial for successful POCUS integration, requiring ongoing training and program development to maintain interest and usage.
Challenges and Importance of Image Integration into Patient Charts
The ability to integrate POCUS images into patient charts enhances patient care quality by providing concrete visual data for reference and discussion. Setting up secure image storage systems and integrating image upload capabilities into the electronic medical record (EMR) streamlines interpretation and consultation processes. Challenges include navigating institutional IT systems and ensuring proper documentation and review processes, which are essential for medical-legal risk management and program sustainability.
Core Components and Training Needs for Developing POCUS Programs
Establishing a POCUS program requires core components such as a structured curriculum, image upload capabilities, robust documentation processes, quality assurance mechanisms, and a credentialing platform. Training fellows in various POCUS applications involves mastering procedures, identifying landmarks, and recognizing diagnostic features across different body systems. Defined standards for competency assessment in POCUS skills are necessary for fellowship training programs to ensure best practices and patient care.
Legal and Quality Assurance Considerations in POCUS Implementation
Incorporating POCUS in clinical practice involves understanding and addressing medical-legal risks. While POCUS is a low-risk intervention, establishing robust quality assurance and documentation processes mitigates potential legal concerns. Transparency and collaboration with experts such as cardiologists and radiologists facilitate effective quality assurance practices. Training programs should focus on improving patient care, implementing QA processes, and building a supportive network to enhance POCUS integration and minimize risks.
Thomas Conlon, MD is a pediatric intensivist at the Children's Hospital of Philadelphia, where he also serves as the Director of Pediatric Critical Care Ultrasound. His professional/research interests include clinical and educational outcomes in diagnostic and procedural ultrasound as well as programmatic ultrasound implementation.
Sarah Ginsburg, MD is an Assistant Professor of Pediatrics at the University of Texas Southwestern and pediatric intensivist at Children’s Medical Center Dallas. Her professional & research interests include clinical applications of POCUS in the PICU. She is very active both locally and nationally in improving POCUS skills for pediatric intensivists, including participating in Pediatric Research Collaborative on Critical Ultrasound, a subgroup of PALISI.
Learning Objectives:
By the end of this podcast, listeners should be able to:
Identify the limitations of the physical exam and lab-based data in evaluating shock at the bedside of critically ill children.
Describe how point-of-care ultrasound might provide greater accuracy in our evaluation of complex shock physiology.
Discuss limitations to our ability as critical care physicians to use point-of-care ultrasound in our clinical practice and suggest solutions to overcome commonly encountered barriers.
References:
Lu et al. Recommendations for Cardiac Point-of-Care Ultrasound in Children: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2023 Mar;36(3):265-277. doi: 10.1016/j.echo.2022.11.010. Epub 2023 Jan 23. PMID: 36697294.
Walker et al. Clinical Signs to Categorize Shock and Target Vasoactive Medications in Warm Versus Cold Pediatric Septic Shock. Pediatr Crit Care Med. 2020 Dec;21(12):1051-1058.
Conlon et al. Diagnostic Bedside Ultrasound Program Development in Pediatric Critical Care Medicine: Results of a National Survey. Pediatr Crit Care Med. 2018 Nov;19(11):e561-e568.
Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med. 2023 Sep;82(3):e115-e155.
Conlon et al. Establishing a risk assessment framework for point-of-care ultrasound. Eur J Pediatr. 2022 Apr;181(4):1449-1457.
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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