ICU Ultrasound Rounds in an Academic Medical Center

Abstract

PURPOSE: The acceptance of physician ultrasound use remains limited. A focused approach to ultrasound has become appealing to intensivists trained from Anesthesiology, Pulmonary and Surgery backgrounds. Ultrasound has become an incredible tool that has become more portable and affordable. At our institution, ultrasound training in emergency medicine (EM) has been ongoing since 1997. In an effort to expand the use of physician bedside ultrasound by intensivists, we sought to develop scheduled weekly ICU rounds for hands on ultrasound education. Given the relative lack of exposure of non-EM physicians to ultrasound training, this project looked to positively affect the culture of intensive care sonography. METHODS: ICU ultrasound rounds took place weekly for 2 hours. Ultrasound teaching faculty included the EM Ultrasound Director, the EM Ultrasound Fellow, Attending Physicians and fellows experienced in ultrasound from Medical and Surgical Intensive Care Units. Attendees included attendings, fellows, residents, and students who were interested in focused ultrasonography. Patients were identified to have pathological findings by prior imaging modalities. Attendees received instruction on the positioning of the machine and patient, image patient identifiers, scanning protocols, image annotation, and machine cleaning for infection control. RESULTS: 20 ICU rounds occurred over 6 months. A total of 95 patients were examined. The participants were 5 attending physicians, 9 fellows, 16 residents, and 29 students. There were 49 focused echos, 10 IVC measurements, 38 focused thoracic and 26 FAST scans by the various participants. CONCLUSION: Our experience emphasizes that a clinical focused ultrasound program can be successfully implemented across departmental disciplines incorporating the expertise of intensivist with varied backgrounds. Our cross-departmental educational activity helped bring ultrasound awareness to the ICU environment that previously did not encounter clinician performed bedside ultrasound outside of central venous access. Further study of perceptions by survey may help identify barriers. CLINICAL IMPLICATIONS: The ICU culture is complex and by repeated exposure to the ultrasound team, the faculty and staff became aware that this was an ongoing project and as a result became more receptive over time.