1 - Developing, Implementing, and Evaluating a Quality Assurance/Quality Improvement Program to Peer Review Point-of-Care Ultrasound Images for Flight Clinicians

Introduction: The use of point of care ultrasound (POCUS) in the prehospital setting is well established (Air Medical Journal, 2018) and is an essential tool in critical care (Amaral et al., 2020). There are no universal guidelines that dictate the use of prehospital ultrasound, indications for use, education and credentialing requirements, quality assurance, or improvement (Amaral et al., 2020). Lack of timely US feedback can impact patient care by incorrect interpretation of images based on practice errors.

Methods: The proposed solution was to implement a robust QA/QI program consisting of a selected nurse or paramedic, that aligned with a regional manager, for a total of 6 individuals that received advanced training and education to perform peer reviews on POCUS images in a consistent and timely manner. Life Link III’s education department designed online modules to peer review US images. This QI project utilized the conceptual framework of the Dreyfus Skill Acquisition Model modified by Patricia Benner and the Plan-Do-Study-Act cycle for implementation. The QI project was implemented at a nonprofit air medical service located in Minnesota. A pretest-posttest design and post-project survey were utilized. Challenges encountered during this project included the Covid19 pandemic creating delay in education/training program development and the inability to meet in person due to concerns of transmission with in-person exposure.

Results: The results were analyzed using a paired t-test to assess for statistical improvement in identifying better quality image acquisition, an increase in accurate image interpretation, and a decrease in image review from submission.

The results of the Wilcoxon test were significant based on an alpha value of 0.05 and a p-value of 0.38. This indicated that the differences between the pre-self-assessment survey and post-self-assessment survey were not likely due to random variation. The median of the pre-self-assessment survey was 6.8 with a standard deviation of 1.643 and was significantly lower than the median of a post-self-assessment survey of 10.40 with a standard deviation of 1.342, indicating there was significant learning of ultrasound reviewer responsibilities and expectations, the peer review process, peer reviewer leadership, communication, and feedback skills, and how to use the QA/QI peer review worksheet

Conclusion : With the establishment of the core group of peers trained to review POCUS images, there has been better quality image acquisition, an increase in accurate image interpretation, and less time from image submission to image review.