Emergency department ultrasound by nurse practitioners

Abstract

Bedside ultrasound (u/s) examinations by emergency physicians (EPs) have been integrated into clinical emergency medicine (EM) training programs and the efficacy and success of an introductory u/s training course, based on established guidelines, has been previously described. We used this same course to teach EM nurse practitioners (NPs) bedside u/s and then assessed the adequacy of NP ultrasonography 1 year following the course. Five NPs were included in a standardized 16-h EM u/s training program. Subsequently, the NPs were asked to print consecutive u/s images representative of their clinical assessments. A single qualified EP reviewer assessed images for adequacy. Five NPs reported 229 u/s examinations, two of which were excluded as nondiagnostic over the 2-month study period. There were 32 inadequate images and 27 "positive" findings. All the positives were correct. Totals per provider were 104, 58, 49, 13, and 3 u/s assessments with 83%, 95%, 84%, 77%, and 100% adequacy of images, respectively. Of the 32 inadequate images, 18 of these were incomplete focused assessment with sonography for trauma (FAST) examinations with a reading of negative for free fluid. NPs are able to perform focused u/s with a high degree of accuracy, and a 16-h guideline-based course serves as a good introductory foundation.