Ultrasound is increasingly a powerful tool for treating children in an emergency situation

Despite the growing use of ultrasound, there have been no published guidelines specific to pediatric emergency medicine. R Baby is investing in this important medical diagnostic tool through grants with the INSPIRE Network-New York Presbyterian Morgan Stanley Children’s Hospital, led by Dr. David Kessler and the Point of Care Ultrasound (POCUS) Training Curriculum at Rutgers Robert Wood Johnson Medical School in Association with Bristol-Myers Squibb Children’s Hospital, Robert Wood Johnson University Hospital led Dr. Ernest Leva.

Ultrasound in ER care for children

can be done quickly at bedside to expedite clinical decision-making.
reduces healthcare costs by reducing the need for more invasive, expensive and potentially unnecessary procedures.
reduces the need to transport a patient outside of the emergency room thus reducing time to diagnosis.
allows examinations to be repeated since there is no ionizing radiation exposure.

The International Network for Simulation-based Pediatric Research, Innovation and Education (INSPIRE)

The International Network for Simulation-based Pediatric Research, Innovation and Education (INSPIRE) has a strong track record of strategically focused research.

ABOUT INSPIRE

The INSPIRE network is the world’s largest pediatric simulation research network, with over 120 pediatrics sites globally and more than 800 members (researchers and educators), and thirty ongoing multicenter research projects. Research conducted through INSPIRE network sites now reaches over 500,000 front-line healthcare providers. R Baby was the first to seed/fund this initiative in 2007 with many more investors joining with our continued support.

INSPIRE network projects fall under one of seven key research themes: debriefing, teamwork, psychomotor skills, technology, acute care, human factors and patient safety. By identifying thematic areas of research, INSPIRE ensures that projects continue to inform each other and advance the field in each of these seven thematic areas. Over the past seven years, INSPIRE network members have successfully secured over six million dollars in research grant support for network-related simulation-based projects.

ABOUT SIMULATION-BASED RESEARCH

Simulation-based research confers several distinct advantages:

Simulated patients can be scheduled on-demand.
Novel interventions can be studied with no risk for patient harm.
The clinical context can be standardized to ensure consistency across providers and teams, thus minimizing confounding variables that typically represent a problem in clinical research.

INSPIRE members share training, research and tools throughout their network providing valuable resources to members. In addition, the network’s research shares best practices and the most up to date tools and training for success.

Ultrasound is one of the most commonly used tools in diagnosing children and has enormous potential to impact a patient’s care by speeding up time to diagnosis, reducing time in the emergency department, and reducing exposure to radiation from other imaging tests. Yet ultrasound is still a relatively new technology. This year, INSPIRE has created simulation training tools that focus initially on the skill of ultrasound interpretation.

Abdominal pain is a very common presenting symptom for children in the emergency department. Differentiating gas pains from serious surgical emergencies is crucial. Unfortunately, physicians less experienced with children often may order too many tests or imaging studies, such as a CT scan which exposes patients to unnecessary radiation and harm.

Bedside ultrasound in the Emergency Department can be a safe, rapid and accurate alternative to radiology imaging for many diagnoses. Experienced physicians are able to identify many serious conditions using ultrasound, but the best way to learn this skill is unknown. The purpose of this project is to determine the optimal training experience for mastery learning of image interpretation to the level of Pediatric Emergency Medicine attending sonologist skills. All participants in the study will be exposed to an online educational module on how to interpret ultrasound images. They will then have an opportunity to practice image interpretation repetitively until they achieve a pre-determined level of mastery.

During this project, 200 physicians, impacting thousands of children, will be trained on increased competency in ultrasound diagnosis. Once the study of this training is complete, this module will then be available to thousands of physicians throughout the network and beyond.

Point of Care Ultrasound (POCUS) Training Curriculum -Rutgers Robert Wood Johnson Medical School in Association with Bristol-Myers Squibb Children’s Hospital, Robert Wood Johnson University Hospital led by Dr. Ernest Leva

Ultrasound is an important tool in identifying and treating children. R Baby seeks to help find robust ways to impact training and care. In addition to supporting INSPIRE’s ultrasound module, we are excited to share the development of a Point of Care Ultrasound (POCUS) training curriculum for the emergency department staff throughout the Robert Wood Johnson University Hospital system with a specific focus for the use in the pediatric emergency department. As a teaching hospital, not only will this training impact current staff, it will reach residents who will ultimately work at different institutions thus sharing this training across the country.

POCUS use in the PED is becoming the standard of care to guide invasive procedures, quickly focusing the evaluation of critically ill patients and driving the adoption of bedside ultrasound by pediatric physicians making care safer, more efficient, and less costly by guiding decision making and reducing complications associated with procedures.

There is substantial emerging evidence that supports the benefits of emergency ultrasound (EUS) use for pediatric patients. EUS has the potential to improve emergency care, specifically in pediatrics. Due to the differences between pediatric and adult patients, the guidelines established by the American College of Emergency Physicians (ACEP) will differ for pediatric patients. Despite the growing use of POCUS by pediatric emergency medicine (PEM) physicians, there have been no published guidelines specific to PEM. The indications in the existing policy statements are written for emergency physicians who predominately care for adult patients. Literature supports the ability to accurately diagnose time sensitive and common ED conditions, which will decrease length of stay and reduce complications while caring for the sickest and most complex pediatric patients.

This POCUS curriculum will keep faculty current with the safest, most efficient, state of the art technical advances in ultrasound technology and includes:

an introduction to emergency ultrasound,
monthly didactics (including online modules, video training, in person presentations and hands on sessions),
hands on scanning instruction sessions (include training on computer modules, educational scans in the PED, and scans during clinical shifts),
scheduled scanning time,
timely image review of individual scans with feedback on image quality and interpretation,
monthly journal club sessions to discuss emerging applications or new evidence,
participation in outside courses when applicable,
and acquisition of educational resources.

Upon completion of the course, there will be a competency assessment that will focus on image acquisition and image interpretation. The technical aspects of the image acquisition and quality are evaluated on probe selection, machine setting, technical skill, quality of image, and inclusion of minimum images for specific applications. The assessment of image interpretation will focus on the decision-making skills using the emergency ultrasound (EUS) images or video clips.

The collaborative’s first goal was to standardize protocols across New Jersey hospitals for head CT scans in children, not only the decision-making process on when a scan was warranted, but also the proper dosage levels for children. The collaborative adopted clinical observation criteria and an algorithm from the Pediatric Emergency Care Applied Research Network to define when imaging is medically indicated. NJHA created a laminated pocket card of the algorithm and shared it with emergency room physicians and nurses across the state. Collaborative members also joined with NJHA in a number of education programs on best practices.

Twelve months later, new data shows that avoidable pediatric head CT scans decreased by twenty-five percent in New Jersey hospitals, translating to 956 unnecessary scans that were avoided. The radiation of a CT head scan for concussions equals 200 chest x-rays.

Now entering its second year, the collaborative’s focus has shifted outside the hospitals’ walls into the community. A new #ScanSmart toolkit developed by NJHA and helps healthcare providers educate parents, coaches, trainers and others with posters and pamphlets highlighting both the benefits and risks of CT imaging.

The collaborative encourages parents to talk with their children’s physicians about the COOL approach:

Consider using other testing (without radiation) when appropriate

Only image the indicated area

Only scan once

Lowest amount of radiation should used, based on child dosing