Evaluation of Implementation of a National Point-of-care Ultrasound Training Program

国家重点超声培训项目实施效果评价 背景：医疗点超声检查(PICUS)已被证明可以减少与手术相关的 侵入性床边手术的并发症，减少诊断时间，并减少辅助测试， 最终减少患者的辐射暴露和医疗成本。尽管它有潜在的优势，但Pocus 由于受过使用Pocus培训的提供者数量有限，因此在医疗保健中并未普遍采用。 VHA的模拟学习、教育和研究网络(SimLEARN)和专业护理中心 创新(SCCOI)发起了一项合作倡议，以制定国家PICUS培训计划。 该协作培训计划的目标是向退伍军人管理局提供者传授基本的诊断和程序 PICUS的应用。拟议的项目将评估沉浸式Pocus培训的有效性。 由Simlearn开发的关于提供商技能获取和保留、使用频率和身份识别的课程 在参与的VHA设施中设置障碍/辅助者以确保使用。 方法：从15个不同的VHA设施中抽取约200名参与者 参加为期2.5天的SIMLEARN国家仿真中心沉浸式PICUS培训课程 奥兰多在2018财年。我们的评估计划将从设施参谋长、供应商 来自参与PICUS培训的机构，以及来自不同时间点的等待名单上的机构的提供者 使用不同的评估工具：VHA设施Pocus调查、提供商Pocus调查、Brief提供商 Pocus调查，课程前/课程后知识和技能测试，以及编码数据。 目标1：评估提供者技能的获得和保留，以及使用Pocus的频率 参加Pocus培训课程。课程前和课程后的测试将用于评估收购 进行PICUS考试所需的知识和技能。课程后的知识和技能测试 保留和使用频率将在培训课程结束后6个月进行。 目标2：确定PINUS培训课程的效果和实施促进 设施级别的Pucus使用频率。具有不经常使用Pocus的提供商的设施将符合条件 参加Pocus培训课程。然而，并不是所有的设施都能容纳在 培训计划的第一年，需要一份设施等待名单。有供应商参与的设施 在使用Pocus的频率方面，将把Pocus培训课程与等候名单上的设施进行比较。 使用简要的提供者Pocus调查，提供者在参与和等待期间使用Pocus的频率- 列出的设施将进行比较。此外，将审查编码数据，以评估程序的频率 在有和没有影像引导的情况下进行手术，并比较两组的手术并发症发生率 设施。 目标3：确定供应商和设施级别的障碍和促进者使用Pocus。提供商和 设施级别的障碍将使用3种工具进行评估：提供商Pocus调查(受过培训的提供商)、简要提供商 Pocus调查(等待名单和参与设施)和设施Pocus调查(所有设施)。差异 将对报告的障碍及其与口袋使用频率的关系进行比较。 交付成果：主要交付成果将是总结培训对提供商技能的影响的报告 获取和保留、使用Pocus的频率，以及Pocus实施的障碍和促进者。 该项目将指导Simlearn和SCCOI努力制定国家Pocus培训计划和 在退伍军人保健系统中实施Pocus在全国范围内的使用。此外，本报告还可以作为 VHA实施类似的基于模拟的教育创新的路线图。

Evaluation of Implementation of a National Point-of-care Ultrasound Training Program Background: Point-of-care ultrasonography (POCUS) has been shown to reduce procedure-related complications from invasive bedside procedures, reduce time to diagnosis, and reduce ancillary testing, which ultimately reduces patient radiation exposure and healthcare costs. Despite its potential advantages, POCUS has not been universally adopted in healthcare due to limited numbers of providers trained in use of POCUS. The VHA's Simulation Learning, Education and Research Network (SimLEARN) and Specialty Care Centers of Innovation (SCCOI) have launched a collaborative initiative to develop a national POCUS training program. The goal of this collaborative training program is to teach VA providers basic diagnostic and procedural applications of POCUS. The proposed project will evaluate the effectiveness of an immersive POCUS training course developed by SimLEARN on provider skill acquisition and retention, frequency of use, and identify barriers/facilitators to POCUS use at participating VHA facilities. Methods: Approximately 200 participants from a convenience sample of 15 diverse VHA facilities will participate in a 2.5-day immersive POCUS training course at the SimLEARN National Simulation Center in Orlando during fiscal year 2018. Our evaluation plan will collect data from facility Chiefs of Staff, providers from facilities participating in POCUS training, and providers from wait-listed facilities at different time points using different assessment tools: VHA Facility POCUS Survey, Provider POCUS Survey, Brief Provider POCUS Survey, Pre-/Post-course Knowledge and Skills Test, and Coding Data. Objective 1: Evaluate provider skill acquisition and retention, and frequency of POCUS use after participation in the POCUS Training Course. Pre- and post-course testing will be used to assess acquisition of knowledge and technical skills to perform POCUS exams. Post-course testing for knowledge and skill retention, and frequency of use, will be performed 6 months after the training course. Objective 2: Determine the effect of the POCUS Training Course and implementation facilitation on facility-level frequency of POCUS use. Facilities with providers that infrequently use POCUS will be eligible to participate in the POCUS Training Course. However, not all facilities will be able to be accommodated in the 1st year of the training program, requiring a facility waiting list. Facilities with providers participating in the POCUS Training Course will be compared to wait-listed facilities with regard to frequency of POCUS use. Using the Brief Provider POCUS Survey, frequency of POCUS use by providers in both participating and wait- listed facilities will be compared. Additionally, coding data will be reviewed to assess frequency of procedures performed with and without imaging guidance and procedural complication rates comparing the two groups of facilities. Objective 3: Determine provider and facility-level barriers and facilitators to POCUS use. Provider and facility-level barriers will be assessed using 3 tools: Provider POCUS Survey (trained providers), Brief Provider POCUS Survey (wait-listed and participating facilities), and Facility POCUS Survey (all facilities). Differences in barriers reported and their relationship to frequency of POCUS use will be compared. Deliverables: The primary deliverable will be report that will summarize the effect of training on provider skill acquisition and retention, frequency of use of POCUS, and barriers and facilitators to POCUS implementation. This project will guide SimLEARN's and SCCOI's efforts to develop a National POCUS Training Program and implement POCUS use nationally in the VA healthcare system. Additionally, this report may serve as a roadmap for the VHA for implementation of similar simulation-based educational innovations.