by Gus Iversen
, Editor in Chief | November 18, 2020
Handheld ultrasound has emerged as a valuable tool for monitoring heart failure and pneumonia in elderly patient populations at the point of care, but utilizing new technology comes with a learning curve. Fortunately, researchers have found training geriatricians to feel confident using the cutting-edge technology can be done in just a few hours.
Dr. Daniel Kim, a fellow in Geriatric Medicine in the Perelman School of Medicine at the University of Pennsylvania, along with a few of his colleagues, put together a point-of-care ultrasound (POCUS) training curriculum that included a hands-on workshop to educate doctors working regularly with older populations. They tested it, using handheld ultrasound systems from Butterfly Network, among four different fellows in geriatric medicine who considered themselves novice users at the start.
"With ultrasound devices like these being handheld, they can fit in your pocket, so it's always available to doctors, like a stethoscope," said Kim, who was also the study's lead author, in a statement. "But physicians must be confident in their ability to use the technology, which means knowing the clinical indications for its usage and how to position the device to obtain adequate images and interpret them afterward." For instance, doctors may use handheld devices for fluid volume assessment, often related to heart failure, as well as checking for urinary retention, pneumonia, and lower extremity blood clots, which are all common among older adults.
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After Kim's four-hour training workshop, the four geriatric medicine fellows' overall comfort and confidence in both using the POCUS device and interpreting the images doubled. By the end of the extended curriculum, which included about an hour of supervised scanning on patients each week, that comfort level almost tripled. These gains took place along three of the four areas of focus that the course covered: bladder, lungs, and internal jugular.
Assessment of the heart was a different story. While usage confidence did increase, confidence in the interpretation of heart images actually declined somewhat.
"A decline in confidence in heart ultrasound image interpretation after a brief training course is not uncommon," said senior author Dr. Nova Panebianco, an associate professor of Emergency Medicine and emergency ultrasound fellowship director. "Cardiac ultrasound is so complex that even cardiologists sometimes obtain additional fellowship training in the subject. I suspect that, with training, the geriatric fellows realized how much more there is to know."
The workshop was held on the first day of the curriculum, January 18, 2020. While scheduled to run for six months, the curriculum was only able to continue into March due to COVID-19. It was then suspended because a large part of the training centered on doing supervised scans, which was not possible with social distancing.
Findings from a study of the approach by Penn Medicine researchers were published recently in the Journal of the American Geriatrics Society