April 12, 2012
Performing an ultrasound at a patient’s bedside is now faster and easier thanks to new state-of-the-art equipment and an innovative training program in London Health Sciences Centre’s emergency departments.
Ultrasound at the bedside, or “point-of-care” ultrasound, has been performed in LHSC’s two emergency departments (EDs) at University Hospital and Victoria Hospital for a number of years, allowing physicians to diagnose time-sensitive and critical issues such as fluid around the heart or internal bleeding. The two new state-of-the-art, point-of-care ultrasound machines in LHSC’s EDs can wirelessly transmit images to the hospital’s computer network, allowing physicians to review ultrasound images taken by residents and provide further feedback and training – an option not previously available to trainees.
“This new equipment and its ability to enrich our residency training program demonstrates LHSC’s commitment to advancing our academic mission while enhancing patient care and safety,” says Bonnie Adamson, President and CEO of London Health Sciences Centre.
Dr. Rob Arntfield, an ED physician and intensivist at LHSC, recently completed a year-long fellowship at The Mount Sinai Hospital in New York, learning and integrating cutting edge point-of-care ultrasound applications into the care of the critically ill patient. Since his return to LHSC, Arntfield has been working with Dr. Drew Thompson, also an LHSC ED physician, to develop new quality assurance training standards to enhance residents’ knowledge and use of this important patient care technology.
“It’s important that we ensure our residents are performing ultrasounds properly, since the success of this equipment is entirely operator-dependent,” says Arntfield, who notes that a slight twist of the ultrasound transducer can yield a totally different image.
“With our new quality assurance training process, most of our residents will now be certified to perform point-of-care ultrasounds in their first year of residency, instead of later in their training,” says Thompson, who works with Arntfield to review many of the images captured by residents. When necessary, they provide feedback and further training to ensure the best images are being captured at the patient’s bedside.
“Before the implementation of this new residency training program, a resident would not have had ready access to further teaching or feedback once he or she was certified in using point-of-care ultrasound,” says Arntfield.
“It used to take most of our five years of residency to obtain certification,” says Dr. Danny Peterson, a fourth-year resident in emergency medicine. “Now, residents will get the bulk of their training up front and many will receive basic certification in their first year.”
To become certified, residents must complete 50 supervised scans for every indication that point-of-care ultrasound is used for, such as diagnosing fluid around the heart or internal bleeding after trauma, assessing for abdominal aneurysms or guiding resuscitation in cardiac arrest.
“As more residents receive their certification earlier, there becomes an increasingly larger pool of certified physicians able to train others, so there are more members of the ED able to contribute to safer patient care,” says Dr. Justin Ahn, a third-year ED resident.
The new quality assurance program will also apply to staff ED physicians, so that they also receive feedback on the quality of their point-of-care ultrasound scans. Ultimately, this will mean all LHSC emergency department physicians—both staff and residents—will have the highest and most developed skills possible for performing point-of-care ultrasounds.
“There is no other centre as large as London Health Sciences Centre in Canada with this kind of rigorous training process,” says Dr. Gary Joubert, chief of emergency medicine. “Our new ultrasound equipment with wireless capabilities, combined with our new quality assurance training process, makes LHSC a leader in safer patient care as it relates to emergency medicine point-of-care ultrasounds.”