Date Available

8-2-2024

Year of Publication

2024

Degree Name

Doctor of Nursing Practice

Advisor

Dr. Holly R. Chitwood

Committee Member

Dr. Candice H. Falls

Co-Director of Graduate Studies

Dr. Andrew C. Bernard

Abstract

Background: Advanced practice providers (APPs) routinely lack the skillset to perform Point of Care Ultrasound (POCUS) because currently, there is not a standardized curriculum within scholarly programs (Santos et al., 2018) and/or inadequate hospital training to perform these competencies (Huang et al., 2021). The absence of a standard curriculum has limited the ability of APPs to practice with full scope, provide care that is comparable to physician partners in the acute care setting, and deliver highest quality of patient care. Implementing standard education to train APPs for POCUS addresses this identified gap.

Purpose: The purpose of this project was to determine if implementing standard POCUS education with the technique of Rapid Ultrasound for Shock and Hypotension (RUSH) resulted in measurable change in the APPs knowledge, perceived significance in clinical practice, interest in further education, and to evaluate patient outcomes.

Methods: A quality initiative with retrospective and prospective chart review was performed with APPs in the Medicine Intensive Care Unit (MICU) and Critical Care Medicine (CCM) and evaluated patient outcomes under the care of those providers. The initiative consisted of structured education regarding the RUSH exam and had accompanying pre and post surveys. Surveys assessed sample demographics and used an independent T-test to compare means of measurement for efficacy of knowledge. Patient charts were selected retrospectively and prospectively by identifying cardiogenic shock as the indication of echocardiographic studies in which MICU and CCM APPs were ordered. The Mann-Whitney U test was used to compare means of measurement with patient outcomes pre and post intervention with vasopressor use, intravenous fluid (IVF) boluses, and length of stay (LOS) in the intensive care unit (ICU). The overall number of echocardiographic studies APPs ordered were collected pre and post survey to evaluate perceived significance in clinical practice. Lastly, the participants’ perceived significance in clinical practice and interest in further education was evaluated on a five-point Likert scale.

Results: Subjects were 14 APPs with MICU and CCM (N=14) with half (50.0%) of whom reported not having any previous ultrasound education or training. There was a statistically significant (p=.008) association between the educational intervention and efficacy of knowledge. As a result of the initiative, APPs perceived the significance of POCUS in clinical practice, new interest in learning more about POCUS, and interest in becoming credentialed in place of practice. An important additional finding of this study is that some APP subjects were unsure whether they were currently billing or credentialed. These findings highlight the educational opportunity and practice gap that exists. The ordered echocardiographic studies increased by nearly 25%, but there was no significant difference in the duration of vasopressor (p = .36), IVF bolus (p = .30), or ICU LOS (p = .24) among patients in the pre and post intervention periods. There is limited generalizability of the findings in this study due to small sample sizes, complex patients, multiple providers, and absence of adjustment for illness severity.

Conclusion: This study demonstrates a gap of POCUS training, education, and skillset experienced by APPs in their scholarly programs and places of employment. The impact of implementing standard education had measurable benefits in knowledge gain and developing interest in POCUS. Future initiatives are focused on promoting full scope of practice potential, autonomy, delivering highest quality of patient care, and revenue capture similar to what is comparable of physician partners.

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