ENHANCING CARDIO-PULMONARY IMAGING ACCESS TO A FIRST NATIONS CARE SETTING USING POINT-OF-CARE ULTRASOUND AND REMOTE LIVE-STREAMING

Abstract

BACKGROUND Point-of-care ultrasound (POCUS) has revolutionized the clinical examination by providing the ability to accurately assess the heart and lungs at the bedside. It is recommended by the American Society of Echocardiography (ASE) as the first-line imaging tool for patients with suspected COVID-19 and cardiopulmonary symptoms. However, physicians practicing in remote or low-resource settings often do not have access to training opportunities. These challenges have been exacerbated by the pandemic. Live-streaming technology offers a novel opportunity to reach physicians that otherwise would be precluded from these opportunities. Our objective was to implement a fully virtual, live-streamed ultrasound teaching and tele-consultation service for non-conventional users of cardiopulmonary ultrasound in an underserviced care setting. METHODS AND RESULTS Physicians with no prior POCUS training at the Kingston Health Sciences Centre and the Weeneebayko General Hospital in Moose Factory, Ontario, were recruited to participate in a 3-week virtual POCUS training program (Fig. 1). All learners completed three e-learning modules based on the ASE COVID-19 POCUS protocol for COVID-19 and participated in a live-streamed virtual workshop led by expert educators. They then received 6-10 individualized, live-streamed tele-POCUS mentorship sessions using novel technology (Philips Lumify ultrasound and audio/video streams via Reacts software), and were evaluated through expert-assessed virtual tests. The primary outcome used to assess learner competence and knowledge retention was the average change in pre- and post-training test scores. All testing components were scored on a 5-point Likert scale. 16 physicians have been enrolled to date, including five family physicians in Moose Factory. In total, 82 tele-POCUS mentorship sessions have been conducted and 9 participants have completed the program. The average improvement between pre- and post-tests among participants who have finished was statistically significant for both cardiac (Average Likert score improved 2.5 to 4.1, p < 0.001) and lung ultrasound (Average Likert score improved 3.1 to 4.3, p < 0.001) components. All novice, remote users demonstrated improvement in device operation, image optimization, and acquisition following the training program despite no face-to-face contact with instructors. CONCLUSION Introductory POCUS skills can be taught to remote users using an entirely virtual, live-streamed format. We have demonstrated that this technology can be used to train physicians regardless of location, and offers a novel method for distributing POCUS skills to remote and low resource settings in Canada. Point-of-care ultrasound (POCUS) has revolutionized the clinical examination by providing the ability to accurately assess the heart and lungs at the bedside. It is recommended by the American Society of Echocardiography (ASE) as the first-line imaging tool for patients with suspected COVID-19 and cardiopulmonary symptoms. However, physicians practicing in remote or low-resource settings often do not have access to training opportunities. These challenges have been exacerbated by the pandemic. Live-streaming technology offers a novel opportunity to reach physicians that otherwise would be precluded from these opportunities. Our objective was to implement a fully virtual, live-streamed ultrasound teaching and tele-consultation service for non-conventional users of cardiopulmonary ultrasound in an underserviced care setting. Physicians with no prior POCUS training at the Kingston Health Sciences Centre and the Weeneebayko General Hospital in Moose Factory, Ontario, were recruited to participate in a 3-week virtual POCUS training program (Fig. 1). All learners completed three e-learning modules based on the ASE COVID-19 POCUS protocol for COVID-19 and participated in a live-streamed virtual workshop led by expert educators. They then received 6-10 individualized, live-streamed tele-POCUS mentorship sessions using novel technology (Philips Lumify ultrasound and audio/video streams via Reacts software), and were evaluated through expert-assessed virtual tests. The primary outcome used to assess learner competence and knowledge retention was the average change in pre- and post-training test scores. All testing components were scored on a 5-point Likert scale. 16 physicians have been enrolled to date, including five family physicians in Moose Factory. In total, 82 tele-POCUS mentorship sessions have been conducted and 9 participants have completed the program. The average improvement between pre- and post-tests among participants who have finished was statistically significant for both cardiac (Average Likert score improved 2.5 to 4.1, p < 0.001) and lung ultrasound (Average Likert score improved 3.1 to 4.3, p < 0.001) components. All novice, remote users demonstrated improvement in device operation, image optimization, and acquisition following the training program despite no face-to-face contact with instructors. Introductory POCUS skills can be taught to remote users using an entirely virtual, live-streamed format. We have demonstrated that this technology can be used to train physicians regardless of location, and offers a novel method for distributing POCUS skills to remote and low resource settings in Canada.