A POCUS-first pathway to streamline care for children with suspected ileocolic intussusception.

OBJECTIVES: As point-of-care ultrasound (POCUS) has emerged as a valuable tool for intussusception screening, this quality improvement study aimed to implement a "POCUS-first" pathway in a Pediatric Emergency Department (ED) to streamline workflow and expedite care for children with suspected intussusception. METHODS: This was a prospective analysis of children diagnosed with ileocolic intussusception in a Pediatric ED between June 2022 and June 2023. The study compared the "POCUS-first" cohort with the group receiving only radiology-performed ultrasound. Key outcomes included physician initial assessment to radiology-performed US time and physician initial assessment to reduction time. Continuous improvement efforts incorporated pediatric emergency medicine physician training, education, and pathway dissemination through plan-do-study-act cycles. RESULTS: The study included 29 patients in the "POCUS-first" pathway group and 70 patients in the non-POCUS group. The "POCUS-first" pathway demonstrated a significantly shorter physician initial assessment to reduction time compared to the non-POCUS group (170.7 min vs. 240.6 min, p = 0.02). Among non-transferred patients, the "POCUS-first" group also had a significantly shorter emergency department length of stay (386 min vs. 544 min, p = 0.047). CONCLUSIONS: Implementation of a "POCUS-first" pathway for managing ileocolic intussusception led to notable improvements in process efficiency. The shorter physician initial assessment to reduction time highlights the potential for expedited decision-making and intervention. These study findings support the potential of this pathway to optimize the management and outcomes of children with ileocolic intussusception.

RéSUMé: OBJECTIFS: Comme l'échographie au point de soin (POCUS) est devenue un outil précieux pour le dépistage de l'intussusception, cette étude d'amélioration de la qualité visait à mettre en œuvre une voie "POCUS-first" dans un service d'urgence pédiatrique (ED) rationaliser le flux de travail et accélérer les soins aux enfants présentant une intussusception suspectée. MéTHODES: Il s'agissait d'une analyse prospective des enfants diagnostiqués avec une intussusception iléo-colique dans un DE pédiatrique entre juin 2022 et juin 2023. L'étude a comparé la cohorte "POCUS-first" avec le groupe recevant uniquement des ultrasons radiologiques. Les principaux résultats comprenaient l'évaluation initiale par le médecin du temps de radiologie effectué aux États-Unis et l'évaluation initiale par le médecin du temps de réduction. Les efforts d'amélioration continue ont incorporé la formation, l'éducation et la diffusion des parcours des médecins en médecine d'urgence pédiatrique par le biais de cycles de plan-do-study-act. RéSULTATS: L'étude a inclus 29 patients dans le groupe "POCUS-first" et 70 patients dans le groupe non-POCUS. La voie "POCUS-first" a démontré une évaluation initiale significativement plus courte du temps de réduction par rapport au groupe non POCUS (170,7 minutes vs. 240,6 minutes, p = 0,02). Parmi les patients non transférés, le groupe "POCUS-first" a également eu une durée de séjour à l'urgence significativement plus courte (386 minutes vs. 544 minutes, p = 0,047). CONCLUSIONS: La mise en œuvre d'une voie "POCUS-first" pour gérer l'intussusception iléo-colique a conduit à des améliorations notables de l'efficacité des processus. L'évaluation initiale plus courte du médecin pour réduire le temps met en évidence la possibilité d'une prise de décision et d'une intervention accélérée. Les résultats de cette étude confirment le potentiel de cette voie pour optimiser la prise en charge et les résultats des enfants atteints d'intussusception iléo-colique.

Outcomes of a Comprehensive Ultrasound Guided Peripheral IV Insertion (USGPIV) Training Program in a Pediatric Emergency Department.

INTRODUCTION: Timely and reliable peripheral intravenous cannulation is an imperative skill in a pediatric emergency department. Utilization of point-of-care ultrasound guidance has proven to significantly improve first-attempt peripheral intravenous cannulation insertion rates in pediatric patients. We sought to develop, implement, and evaluate an ultrasound-guided peripheral intravenous training program for emergency nurses in a tertiary care pediatric center. METHODS: Twelve emergency nurses underwent a training program that consisted of an interactive asynchronous learning module followed by 8 hours of training by a vascular access clinical instructor. Data was collected on each ultrasound-guided peripheral intravenous insertion via survey methodology. RESULTS: Complete data for a total of 210 ultrasound-guided peripheral intravenous were recorded over the 9-month period. A total of 65.2% (137/210) of patients who received an ultrasound-guided peripheral intravenous had known difficult intravenous access on history. A total of 89.5% (188/210) of patients had a difficult intravenous access of ≥4. The mean difficult intravenous access score for the patients in which ultrasound-guided peripheral intravenous insertions were attempted was 4.78 (95% confidence interval, 4.55-5.01). A total of 193 of 210 (91.9%) of ultrasound-guided peripheral intravenous were attained successfully. On the first attempt, 86.5% (167/193) ultrasound-guided peripheral intravenous were attained, and 98.96% (191/193) were attained within the first 2 attempts. CONCLUSION: We found that implementing a comprehensive ultrasound-guided peripheral intravenous training program for emergency nurses in a pediatric tertiary care center led to a high first-pass success rate in attaining peripheral intravenous cannulations. It also facilitates vascular access in patients with known difficult intravenous access. Consideration should be made to implementing point-of-care ultrasound intravenous training programs to improve pediatric vascular access in the emergency department, particularly in patients with known difficult intravenous access.

Development of a blended learning curriculum to improve POCUS education in a pediatric emergency medicine training program.

We engaged in curriculum enhancement of POCUS training in our pediatric emergency medicine subspecialty training program using Kern's model of curricular development. We enhanced existing training to include focused asynchronous learning of image interpretation, longitudinal scanning shifts, and quarterly progress report score cards and check-ins for improved communication, transparency and reinforcement of goals. Our approach could inform other training programs looking to improve their POCUS curricula.

RéSUMé: Nous travaillons sur l'amélioration du curriculum de la formation d'échographie d'urgence de notre programme d'urgences pédiatriques en utilisant le modèle de développement de curriculum de Kern. Nous avons amélioré la formation existante pour y inclure un apprentissage asynchrone ciblé de l'interprétation des images, des sessions pratiques d'échographie longitudinales, ainsi que des cartes de pointage et des contrôles trimestriels pour améliorer la communication, la transparence et le renforcement des objectifs. Notre approche pourrait être utile à d'autres programmes de formation cherchant à améliorer leurs programmes d'échographie d'urgence.