Effectiveness of education in point-of-care ultrasound-assisted physical examinations in an emergency department: A before-and-after study
Implementation of point-of-care ultrasonography (POCUS)-assisted physical examination (PE) in emergency departments (EDs) was conducted in the ED of an urban tertiary teaching hospital. This study examines the effect of POCUS implementation in emergency medicine departments by using a systematic education program on image acquisition to analyze decision making.
Educating staff on POCUS involved a technique related to image acquisition and then accurately diagnosing subsequent POCUS results. The quasi-experimental, uncontrolled before-and-after study was performed to evaluate the education effect. POCUS orders for eligible patients, length of stay (LOS) in ED, and return visits (RVs) to ED between the “before” period (March 1, 2015 to February 28, 2016) and the “after” period (March 1, 2016 to February 28, 2017) were compared. Piecewise regression was used to assess trend differences of LOS and RVs between the periods.
A total of 16,942 and 16,287 patients were included in the before and after periods of education, respectively. During the study periods, 966 (6%) and 2801 (18%) POCUS were ordered, respectively (rate difference = 12%; P < .001). Before the education, the median LOS was 6.55 (interquartile rage [IQR]: 6.2–6.75) and the trend slope of LOS was −0.01. After the education, the median LOS was 5.25 (IQR: 4.85–5.45) and the trend slope (the change of which was considered significant, at a P value of .012) was −0.15. Before the education, the median RV rate was 6.4% (IQR: 6.15–6.65) and the trend slope of RVs was −0.01. After the education, the median RVs was 5.25% (IQR: 4.95–5.35) and the trend slope of RVs was also significant, at −0.11.
The education of POCUS-PE in ED successfully increased use of POCUS, and reduced the LOS and RV rate in ED.