APPROACH TO FORMALIZED ULTRASOUND CREDENTIALING

Transcription

1 APPROACH TO FORMALIZED ULTRASOUND CREDENTIALING S. MEYERING DO, APCA(EM-POCUS), FAAEM SPECTRUM HEALTH LAKELAND HOSPITAL SYSTEM, A MICHIGAN STATE UNIVERSITY POST- GRADUATE TRAINING INSTITUTION EMERGENCY MEDICINE RESIDENCY PROGRAM EMERGENCY MEDICINE & CRITICAL CARE ULTRASOUND FELLOWSHIP PROGRAM.

2 NO DISCLOSURES 2

3 US Credentialing 3 Hospital System 2 Academic Hospitals 1 Community Hospital/Rural Total Volume ~100k ED visits US Utilization Billing, Image acquisition/storage, QA/QC/QI, well established Physicians, APPs, Medical students, RN s These providers vary in training, comfort, competency, and use of ultrasound. Proficiency with an ultrasound has quickly become an essential requirement US is becoming standard of care in Emergency Medicine. 3

4 CREDENTIALING ACEP guidelines recommend ultrasound studies or of a particular exam/subset (i.e. E-FAST, gallbladder, OBGYN, vascular etc.) for a provider to be credentialed 1. ACEP Guidelines Hospital Credentialing minimum requirements US faculty recommendations YOUR COMPANY NAME 4

5 Poll Few questions to assess baseline comfortability with US Prior US exposure Ultrasound exposure (medical school/np school/pa school), Post graduate (Residency/Fellowship), Clinical training (for advanced practice providers or physicians who did not complete formal ultrasound training), Sim lab/model instruction, or National Training Course/CME workshop exposure? Dedicate time in residency # scans Self perceived competency level Formal Ultrasound (Radiologist interpreted) is available for clinical comparison Formal Ultrasound reading or backup reading not available 5

6 Pre assessment responses 28 participants (23 Boarded Physicians, 4 APPs) Of the 28 participants, the majority (19) had received formal ultrasound training primarily in residency. The minimum time spent of dedicated training was 2 weeks with a maximum of 2 months. Training: 1 was fellowship trained in ultrasound 4 had been to formal ultrasound courses including national courses, university-based training courses, or courses consisting of CME. 4 respondents had no prior formal training. Min 100 scans, max 250 (requirements for graduation) 20 respondents very comfortable Competency 18 Skills Average 8 Below avg 2 Excellent All respondents noted they felt competent to perform an ultrasound in a setting where radiology interpreted ultrasound was available for comparison. Only 16 respondents noted they felt absolutely comfortable performing POC ultrasound without the ability to order a comparison study. 6

7 Pre- assessment Quiz Basic US information regarding probe position, scanning technique Trauma scenarios Artifacts Technique ie methods to evaluate EF% Abormalities 7

8 QUIZ RESULTS The score was noted on a ten-point scale. Highest score - 10 Lowest - 3 Average score 7.3 for all initial attempts. 20/28 tested passed the pre-assessment quiz on initial attempt Additional 6 achieving a passing score after second attempt. 8

9 Clinical Assessment Live and Sim models. Cardiac, EFAST, Aorta, and Early Pregnancy study Instrumentation and technique Probe placement Probe orientation Artifacts or image quality Image acquisition. Image interpretation and evaluation. Asked questions on what abnormalities they have noted or are being assessed for depending on the specific image or study being acquired. Shown pictures of abnormal findings of multiple studies and asked to interpret the images. Score x/4 for each category min score 32/40 to pass 9

10 CLINICAL ASSESSMENT Clinical Competency Examination (Figure1) Initial attempt score Initial Repeat attempt score 2nd Repeat attempt Score Twenty of the 28 tested passed the evaluation on the initial attempt. Five passed on a first remediation. 3 required more than 1 initial revision attempt. All those that did remediate were able to complete the revision with a passing score (Figure 1) Reflects the scoring of initial competency exam attempt and for those who scored <32, their repeat score upon initial remediation. Your company name 10

11 Discussion ACEP provided good guidelines for the basics of credentialing process Wanted a way for providers to demonstrate their proficiency with image acquisition and interpretation. Ongoing established QA/QI institutionally - Difficult to assess if providers truly know and understand what they are looking for and at with the ultrasound. Varied levels of training/exposure with residency and APP training Attending comfortability and oversight of residents, APP and student image acquisition Encouraging results of testing several perfect/near perfect scoring Prior experience residency/fellowship Remediators Deficits in knowledge base CME, training courses, national CME, in house, online Credentialing model now being utilized by other systems 11

12 THANK YOU References Medicine American College of Emergency Physicians policy statement titled "Definition of an Emergency Physician" revised April Emergency Department Ultrasound Credentialing: a sample policy and procedure. J Emerg Med Aug;37(2): doi: /j.jemermed Epub 2008 Jun 2. Emergency department ultrasound services by emergency physicians: model for gaining hospital approval. Ann Emerg Med Mar;29(3): Differential use of diagnostic ultrasound in U.S. Emergency departments by time of day. West J Emerg Med Feb;12(1):90-5. Emergency department resource use by supervised residents vs attending physicians alone. JAMA Dec 10;312(22): doi: /jama