Mid-level providers demonstrate proficiency in FAST after directed training
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Mid-level providers demonstrate proficiency in FAST after directed training Virgil W. Davis • J. Michael Wallace • Matthew T. Ahern • Matthew S. Dawson • Deborah F. Battaglia • Kelly L. Sherwood • Steve A. Sugerman • Michael P. Mallin Troy E. Madsen
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Received: 7 February 2011 / Accepted: 15 April 2011 / Published online: 1 May 2011 Ó Springer-Verlag 2011
Abstract Introduction Focused Assessment with Sonography for Trauma (FAST) is commonly used to detect intra-peritoneal blood as part of the evaluation of trauma patients. In our level 1 trauma center, mid-level providers (MLPs) perform serial FAST exams on trauma patients. We describe our training approach and proficiency achieved. Methods Subjects were MLPs with no previous training in FAST. The training consisted of hands-on training on live models, two on-line ultrasound (US) modules, and a video image review session. Participants were evaluated with pre-, post-, and 6-month follow-up video tests. Subsequently, they independently performed FAST exams which were reviewed by ED US faculty. Results 11 MLPs participated, completing an average of 17 scans; 91% were technically adequate. Average scores were: pre-test 50.5% (31.7–68.3%), post-test 76.7% (65.9–87.8%), and 6-month test 77% (58.5–87.8%), for an initial improvement of 26.2% (p \ 0.001) and a sustained improvement over the pre-test of 26.5% (p = 0.011) at 6 months. Conclusion MLPs demonstrated proficiency in FAST after brief training. Keywords Trauma Ultrasound Emergency department Mid-level providers
V. W. Davis (&) J. M. Wallace M. T. Ahern M. S. Dawson D. F. Battaglia K. L. Sherwood S. A. Sugerman M. P. Mallin T. E. Madsen Division of Emergency Medicine, University of Utah School of Medicine, 30 N. 1900 E. 1C26, Salt Lake City, UT 84132, USA e-mail: [email protected]
Introduction Focused Assessment with Sonography for Trauma (FAST) scanning is an ultrasonographic assessment for intraperitoneal blood that is part of the initial trauma workup and has shown to improve patient outcomes [1]. Serial FAST scanning is gaining acceptance in the United States [2]. Historically, this has been performed by physicians. With increasing involvement of mid-level providers (MLPs) in the care of trauma patients, we hypothesized that MLPs could learn to perform serial FAST scanning using established training.
Methods The study took place at an academic level 1 trauma center with an annual volume of 39,000 patients. An emergency department observation unit (EDOU) is staffed by MLPs supervised by ED physicians. The EDOU accepts stable trauma patients who require observation for possible occult injuries. Such trauma patients receive serial abdominal exams, serial hematocrit testing, and reevaluation by the trauma team. As part of a quality improvement project, serial FAST exams were added to this trauma pathway. A training and credentialing program was developed to train the EDOU MLPs in this modality, adapting training utilized for physician providers. This study is a r
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