- Email: [email protected]
306 Assessment of Interest and Confidence in Ultrasonography Skills Amongst Emergency Medicine Residents
Research Forum Abstracts inpatient hospice unit from the ED spend a similar amount of time on hospice compared to those transferred from other sites.
305
Profile and Impact of Physician Assistants in Emergency Medicine
Mauldin S, Arbet S, Thomas G/National Commission on Certification of Physician Assistants, Johns Creek, GA; Arbet Consulting, Philadelphia, PA
Study Objective: Prior to the introduction of its new Certificate of Added Qualifications program for certified physician assistants specializing in emergency medicine, the National Commission on Certification of Physician Assistants (NCCPA) conducted a practice analysis to study the knowledge and skills used by those physician assistants and the functions they perform within the specialty. This study presents the findings from that analysis, providing insight into the role that certified physician assistants are fulfilling in emergency medicine and into the demographic and practice characteristics of those physician assistants as compared to the larger population of certified physician assistants. This information will be useful to those considering incorporating physician assistants into an emergency medicine practice and to those concerned about workforce issues. Materials and Methods: The practice analysis was conducted in 2010 as a 2-stage process involving focus groups and an online survey distributed to all certified physician assistants (n⫽71,351); responses were received from 16,289 (23%) including 1,655 who identified emergency medicine as their primary specialty. Results: The study illuminates characteristics such as employment setting, number of clinical hours worked, inter-specialty mobility, and a number of other practice profile factors. It also quantified the frequency and importance of the application of over 300 knowledge and skill areas. Conclusion: By understanding the role certified physician assistants are currently fulfilling in emergency medicine and the demographic and professional profile of those physician assistants, employers, physicians and policymakers will be better positioned to influence the emergency medicine workforce and address current and future provider shortages.
306
Assessment of Interest and Confidence in Ultrasonography Skills Amongst Emergency Medicine Residents
ob/gyn ultrasonographys. Table 1 (below) lists the changes in operator comfort level before and after individual ultrasonography exams. The z-test for proportions was used to calculate statistical significance between before and after data. Conclusion: Our pilot study demonstrates feasibility and some statistically significant gain in operator comfort level when instituting a formal ultrasonography rotation, which may be helpful for emergency medicine residency programs.
307
Ultrasonography-guided Peripheral Venous Access: A Systematic Review
Liu Y, Alsaawi A, Björnsson H, McCarthy M/The George Washington University, Washington, DC; King Abdulaziz Medical City at National Guard Health Affairs, Riyadh, Saudi Arabia; Landspitali University Hospital, Reykjavik, Iceland
Patel SS, Nickels L, Stead L, Flach F/University of Florida, Gainesville, FL
Background: The use of ultrasonography in emergency medicine has grown considerably in recent years. This modality is especially useful because it is quick, noninvasive, and relatively inexpensive. Because ultrasonography use is increasing in emergency departments, some residency programs have recently started to incorporate formal emergency ultrasonography training into their curriculum. Few studies have evaluated the impact of formal emergency ultrasonography training on emergency medicine residents. Study Objectives: The purpose of this study is to evaluate the baseline ultrasonography interest, confidence, knowledge and technical skill amongst emergency medicine residents and to identify trends in these before and/or after formal emergency ultrasonography training. This sub-study focuses on operator interest and confidence, while another sub-study focuses on knowledge and technical skill. Methods: Design: This is a cross-sectional study comprised of an anonymous 18-question survey administered electronically via SurveyMonkey. Setting: This study was conducted at an academic tertiary care center and level I trauma center. Participants/Subjects: The study was electronically sent to all current emergency medicine residents, from the PGY1 to PGY3 level. Data analysis: Results were collated using Survey Monkey tools. Descriptive statistics were used for data involving level of training and whether or not participants have completed formal ultrasonography training. For normally distributed variables, parametrics were used. For skewed variables, nonparametrics were used. Results: We had a 100% survey response rate. 17.4% of participants had formal emergency ultrasonography training prior to starting residency. At the time of the survey, 65.2% of residents had completed the ultrasonography rotation during residency. Among those who completed the rotation, 58.8% had an increased interest in pursuing a fellowship in emergency ultrasonography after the rotation, while 41.2% had no change in their interest. Of the various indications for emergency ultrasonography, those which over 90% of residents feel that emergency medicine residents should be comfortable with at the end of residency include: the FAST, obtaining peripheral and central venous access, and transabdominal and transvaginal
Volume , . : October
Study Objectives: A systematic review to compare the success rate of ultrasonography-guided peripheral intravenous access to traditional techniques in patients with difficult peripheral intravenous access Method: A systematic review protocol was created a priori by the investigators. A comprehensive search strategy was developed for Ovid MEDLINE and executed in the indexing languages of 4 databases. Four registries and 8 society conference proceedings were searched electronically using the same keyword search applied for Ovid MEDLINE. Field experts were contacted for unpublished studies or work in progress and reference of studies included for final reviews were searched manually for relevance. We included randomized controlled trials comparing ultrasonographyguided peripheral intravenous access to traditional techniques in patients of any age with difficult peripheral intravenous access. Studies were excluded if we were unable to obtain pertinent data through author contact, or if central venous access, external jugular vein access, or peripherally inserted central catheters were studied. Primary outcome measured successful peripheral intravenous access catheterization. Secondary outcomes included duration and number of attempts. Three authors performed the search, 2 authors independently scanned titles and abstracts for relevant studies that meet the inclusion criteria. Full text of any titles identified as relevant by any of the 2 authors were retrieved and independently abstracted into a standard data abstraction form. A third author arbitrated any difference. Based on the data abstraction form studies were selected for inclusion in final review. The PRISMA statement for reporting of systematic reviews was followed, and assessment of risk of bias was performed for all studies included for review. Results: 1570 titles resulted from the electronic search and 2 additional titles from grey literature search. 41 full text articles were retrieved and abstracted into the data abstraction form, 1531 titles were excluded after title and abstract review. Three articles were included in the final review for a total of 144 patients. The 3 studies took place in the operating suites and emergency departments. One study included pediatric subjects younger than 10 years of age. The randomized controlled trials found no difference in peripheral intravenous access success rate between ultrasonography and traditional techniques. No significant difference for procedure duration and number of attempts were found. Risk of bias was identified in one study
Annals of Emergency Medicine S109
305
Profile and Impact of Physician Assistants in Emergency Medicine
Mauldin S, Arbet S, Thomas G/National Commission on Certification of Physician Assistants, Johns Creek, GA; Arbet Consulting, Philadelphia, PA
Study Objective: Prior to the introduction of its new Certificate of Added Qualifications program for certified physician assistants specializing in emergency medicine, the National Commission on Certification of Physician Assistants (NCCPA) conducted a practice analysis to study the knowledge and skills used by those physician assistants and the functions they perform within the specialty. This study presents the findings from that analysis, providing insight into the role that certified physician assistants are fulfilling in emergency medicine and into the demographic and practice characteristics of those physician assistants as compared to the larger population of certified physician assistants. This information will be useful to those considering incorporating physician assistants into an emergency medicine practice and to those concerned about workforce issues. Materials and Methods: The practice analysis was conducted in 2010 as a 2-stage process involving focus groups and an online survey distributed to all certified physician assistants (n⫽71,351); responses were received from 16,289 (23%) including 1,655 who identified emergency medicine as their primary specialty. Results: The study illuminates characteristics such as employment setting, number of clinical hours worked, inter-specialty mobility, and a number of other practice profile factors. It also quantified the frequency and importance of the application of over 300 knowledge and skill areas. Conclusion: By understanding the role certified physician assistants are currently fulfilling in emergency medicine and the demographic and professional profile of those physician assistants, employers, physicians and policymakers will be better positioned to influence the emergency medicine workforce and address current and future provider shortages.
306
Assessment of Interest and Confidence in Ultrasonography Skills Amongst Emergency Medicine Residents
ob/gyn ultrasonographys. Table 1 (below) lists the changes in operator comfort level before and after individual ultrasonography exams. The z-test for proportions was used to calculate statistical significance between before and after data. Conclusion: Our pilot study demonstrates feasibility and some statistically significant gain in operator comfort level when instituting a formal ultrasonography rotation, which may be helpful for emergency medicine residency programs.
307
Ultrasonography-guided Peripheral Venous Access: A Systematic Review
Liu Y, Alsaawi A, Björnsson H, McCarthy M/The George Washington University, Washington, DC; King Abdulaziz Medical City at National Guard Health Affairs, Riyadh, Saudi Arabia; Landspitali University Hospital, Reykjavik, Iceland
Patel SS, Nickels L, Stead L, Flach F/University of Florida, Gainesville, FL
Background: The use of ultrasonography in emergency medicine has grown considerably in recent years. This modality is especially useful because it is quick, noninvasive, and relatively inexpensive. Because ultrasonography use is increasing in emergency departments, some residency programs have recently started to incorporate formal emergency ultrasonography training into their curriculum. Few studies have evaluated the impact of formal emergency ultrasonography training on emergency medicine residents. Study Objectives: The purpose of this study is to evaluate the baseline ultrasonography interest, confidence, knowledge and technical skill amongst emergency medicine residents and to identify trends in these before and/or after formal emergency ultrasonography training. This sub-study focuses on operator interest and confidence, while another sub-study focuses on knowledge and technical skill. Methods: Design: This is a cross-sectional study comprised of an anonymous 18-question survey administered electronically via SurveyMonkey. Setting: This study was conducted at an academic tertiary care center and level I trauma center. Participants/Subjects: The study was electronically sent to all current emergency medicine residents, from the PGY1 to PGY3 level. Data analysis: Results were collated using Survey Monkey tools. Descriptive statistics were used for data involving level of training and whether or not participants have completed formal ultrasonography training. For normally distributed variables, parametrics were used. For skewed variables, nonparametrics were used. Results: We had a 100% survey response rate. 17.4% of participants had formal emergency ultrasonography training prior to starting residency. At the time of the survey, 65.2% of residents had completed the ultrasonography rotation during residency. Among those who completed the rotation, 58.8% had an increased interest in pursuing a fellowship in emergency ultrasonography after the rotation, while 41.2% had no change in their interest. Of the various indications for emergency ultrasonography, those which over 90% of residents feel that emergency medicine residents should be comfortable with at the end of residency include: the FAST, obtaining peripheral and central venous access, and transabdominal and transvaginal
Volume , . : October
Study Objectives: A systematic review to compare the success rate of ultrasonography-guided peripheral intravenous access to traditional techniques in patients with difficult peripheral intravenous access Method: A systematic review protocol was created a priori by the investigators. A comprehensive search strategy was developed for Ovid MEDLINE and executed in the indexing languages of 4 databases. Four registries and 8 society conference proceedings were searched electronically using the same keyword search applied for Ovid MEDLINE. Field experts were contacted for unpublished studies or work in progress and reference of studies included for final reviews were searched manually for relevance. We included randomized controlled trials comparing ultrasonographyguided peripheral intravenous access to traditional techniques in patients of any age with difficult peripheral intravenous access. Studies were excluded if we were unable to obtain pertinent data through author contact, or if central venous access, external jugular vein access, or peripherally inserted central catheters were studied. Primary outcome measured successful peripheral intravenous access catheterization. Secondary outcomes included duration and number of attempts. Three authors performed the search, 2 authors independently scanned titles and abstracts for relevant studies that meet the inclusion criteria. Full text of any titles identified as relevant by any of the 2 authors were retrieved and independently abstracted into a standard data abstraction form. A third author arbitrated any difference. Based on the data abstraction form studies were selected for inclusion in final review. The PRISMA statement for reporting of systematic reviews was followed, and assessment of risk of bias was performed for all studies included for review. Results: 1570 titles resulted from the electronic search and 2 additional titles from grey literature search. 41 full text articles were retrieved and abstracted into the data abstraction form, 1531 titles were excluded after title and abstract review. Three articles were included in the final review for a total of 144 patients. The 3 studies took place in the operating suites and emergency departments. One study included pediatric subjects younger than 10 years of age. The randomized controlled trials found no difference in peripheral intravenous access success rate between ultrasonography and traditional techniques. No significant difference for procedure duration and number of attempts were found. Risk of bias was identified in one study
Annals of Emergency Medicine S109