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 review of prospectively collected quality improvement data.
The EDOU and ED trauma service is staffed by 11 MLPs. None of the 11 MLPs had prior ultrasound training and all were involved in care of trauma patients in both the ED and EDOU. The 11 MLPs participating consisted of 10 physician assistants and one nurse practitioner.
Two outcome measures were evaluated to establish competency, technical competency and interpretative ability. To evaluate technical proficiency, we required MLPs to complete independent FAST scans which were reviewed for adequacy either by real time or by review of electronic images and video clips. Because the frequency of positive FASTs was anticipated to be low, we utilized performance on a video test to evaluate the ability to identify positive scans. This test consisted of 41 multiple choice questions, the majority of which refer to US video images. By including a wide range of image quality, length and interpretative difficulty, the exam was intended to be fairly difficult. The questions required both the correct identification of the presence or absence of free fluid and its location. The tests administered were the same for the pre-training, post-training, and 6 month evaluations; participants were not provided with correct answers until they had completed all three exams.
Prior to training, the video pre-test was administered. After completion, MLPs completed on-line education modules on ultrasound physics and FAST exams (3rd Rock Ultrasound, LLC Module 2 Ultrasound Physics and Principles and Module 11 Trauma Ultrasound, http://www.emergencyultrasound.com).
After all MLPs had completed the on-line training and the ungraded quizzes, a 2-h hands-on session was conducted during which machine function and scanning techniques were taught. The training focused primarily on scanning of live models until each MLP demonstrated adequate ability to obtain the FAST images. A 1-h video review of FAST scans was then conducted.
After this training was completed, the MLPs were administered a post-test. MLPs then were asked to complete 20 independent FAST exams either directly supervised by ED US faculty or to submit still or video electronic images for review. A 6-month post-test was then administered, which ended the training portion of this project.
Paired samples t test was used to measure differences in the results of the pre- and post-training tests (SPSS v. 17.0). Results are reported with ranges of test score results and p values for the difference in pre- and post-training tests.