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Surgeon-Performed
         Ultrasound
 Privileges, Competency and
           Practice
The Results of an ACS Survey
    Gra...
Scanning the Future
     As an extension of the
     physical examination,
ultrasound is a diagnostic tool:

  • Solve cli...
Scanning the Future
              Introduction

Ultrasound is not a “conventional” part of
            surgical practice

...
Scanning the Future
              Introduction
Purpose of survey:

 To ascertain information from surgeons
     about ultr...
Scanning the Future
                Methods

Survey:       Mailed to 1,791 surgeons

Surgeons:     Participated in an ACS
...
Scanning the Future
               Methods
            Questions 6-12:
#          FOCUS OF QUESTION


6   Number of ultras...
Scanning the Future
               Methods
#           FOCUS OF QUESTION

9    Which company manufactured your
     ultras...
Scanning the Future
                    Methods
Competent:
         Ability to perform an ultrasound
      examination/pro...
Scanning the Future
                Methods
Statistics:

     Statistical analysis of categorical
      data was performed...
Scanning the Future
                 1,791 Surveys


                 873 Surgeons



         576 did US          297 did...
Scanning the Future
           Results
Ultrasound in 1 clinical area
    AREA     # OF SURGEONS
 Breast      142 (53.2%)  ...
Scanning the Future
           Results
Ultrasound in 1 clinical area
    AREA     # OF SURGEONS
 Breast      142 (53.2%)  ...
Scanning the Future
                    Results

     Assessment of Competency:

                  576 Surgeons



      2...
Scanning the Future
       Results
     Clinical area
       Breast
    Acute Setting
      Vascular
Intraop/Laparoscopic
...
Scanning the Future
             Results
 Competence by clinical area

  AREA        # EXAMINATIONS

MOST AREAS         1-...
Scanning the Future
                     Results
                   Competency:
           Ultrasound-guided procedures
  ...
Scanning the Future
                   Results
              Access of Equipment

                 580 Surgeons

         ...
Scanning the Future
              Results
Locations of Ultrasound Machines
      AREA         # OF MACHINESS
 Office      ...
Scanning the Future
         Results

    576 surgeons


 386 restricted (67%)

Where?
    Radiology = 55.4%
    Office   ...
Scanning the Future
         Conclusions

 1. Surgeons successfully use
         ultrasound and
     more than half do so
...
Scanning the Future
                Conclusions
    3. In general, surgeons report
          competency with < 20
       u...
Scanning the Future

“Acute Setting” Ultrasound Changes

1997: Trauma-related examinations

         Hemopericardium
     ...
Scanning the Future

 “Acute Setting” Ultrasound Changes
                2000:
Trauma/Critical Care/Acute Gen. Surg.


   ...
Scanning the Future
          Conclusions

   4. Surgeons have access
to ultrasound machines in all
     patient care area...
Scanning the Future
         Conclusions

5. There is widespread use of
    ultrasound by surgeons
  but, they are still r...
Scanning the Future
                    Discussion
             AIUM recommends:
   interpretation of 300 abdominal/genera...
Scanning the Future
                  Discussion
   Ownership of an ultrasound machine
                      +
      the s...
Scanning the Future
         Discussion

       The performance and
interpretation of the examination
          with integ...
Scanning the Future
         Recommendations
     for scanning the future…

Expert surgeon-sonographers
      develop guid...
Scanning the Future
     Recommendations
 for scanning the future…

The American College of
       Surgeons
continue to be...
Surgeon Performed Ultrasound Privileges, Competency And Practice
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Surgeon Performed Ultrasound Privileges, Competency And Practice

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Transcript of "Surgeon Performed Ultrasound Privileges, Competency And Practice"

  1. 1. Surgeon-Performed Ultrasound Privileges, Competency and Practice The Results of an ACS Survey Grace S. Rozycki, MD, RDMS, FACS Vice Chair, Technology/Research ACS Executive Committee National Ultrasound Faculty
  2. 2. Scanning the Future As an extension of the physical examination, ultrasound is a diagnostic tool: • Solve clinical problems • Contribute to the intraoperative management of their patients
  3. 3. Scanning the Future Introduction Ultrasound is not a “conventional” part of surgical practice therefore Questions are raised about the surgeon’s education, training, privileges, and competency in this modality
  4. 4. Scanning the Future Introduction Purpose of survey: To ascertain information from surgeons about ultrasound as it relates to education (training), privileges, competency, and practice
  5. 5. Scanning the Future Methods Survey: Mailed to 1,791 surgeons Surgeons: Participated in an ACS Ultrasound Course(s) Period: 1998-2000
  6. 6. Scanning the Future Methods Questions 6-12: # FOCUS OF QUESTION 6 Number of ultrasound examinations performed before competent 7 Type and # of US-guided procedures/month 8 Number of procedures performed before competent
  7. 7. Scanning the Future Methods # FOCUS OF QUESTION 9 Which company manufactured your ultrasound machine? 10 Where was the ultrasound machine located? 11 In which areas were you restricted form performing ultrasound? 12 If not performing ultrasound, why?
  8. 8. Scanning the Future Methods Competent: Ability to perform an ultrasound examination/procedure so that other diagnostic tests were not needed to confirm the result. Clinical area (relative to ultrasound): Abdominal, Acute Setting, Breast, Endoluminal, Head/Neck, Intraoperative/Laparoscopic, Vascular
  9. 9. Scanning the Future Methods Statistics: Statistical analysis of categorical data was performed using SAS and categorical variables were analyzed using Chi Square test.
  10. 10. Scanning the Future 1,791 Surveys 873 Surgeons 576 did US 297 did not do US (66%) (34%) 267 = 1 area 309 > 1 area
  11. 11. Scanning the Future Results Ultrasound in 1 clinical area AREA # OF SURGEONS Breast 142 (53.2%) Early Acute 59 (10.4%) courses Vascular 27 (4.8%) Later Intraop/Lap 16 (2.8%) courses Endoluminal 14 (2.5%) Head/Neck 5 (0.9%) Abdominal 4 (0.7%) TOTAL = 267 (100%)
  12. 12. Scanning the Future Results Ultrasound in 1 clinical area AREA # OF SURGEONS Breast 142 (53.2%) Early Acute 59 (10.4%) courses Vascular 27 (4.8%) Later Intraop/Lap 16 (2.8%) courses Endoluminal 14 (2.5%) Head/Neck 5 (0.9%) Abdominal 4 (0.7%) TOTAL = 267 (100%)
  13. 13. Scanning the Future Results Assessment of Competency: 576 Surgeons 267 = 1 area 309 > 1 area Statistical comparison showed no difference (p >0.6)
  14. 14. Scanning the Future Results Clinical area Breast Acute Setting Vascular Intraop/Laparoscopic Endoluminal Head/Neck Abdominal
  15. 15. Scanning the Future Results Competence by clinical area AREA # EXAMINATIONS MOST AREAS 1-20 (11-20) *ACUTE 21-30 SETTING
  16. 16. Scanning the Future Results Competency: Ultrasound-guided procedures 576 Surgeons 267 = 1 area 309 > 1 area Statistical comparison showed no difference (p >0.6), except for breast ultrasound-guided procedures (p <0.04), competent after performing about 10 examinations
  17. 17. Scanning the Future Results Access of Equipment 580 Surgeons 576 do US 4 do not do US Access to 1,175 ultrasound machines (2 machines/surgeon) 78% owned similar machines as used in the ACS courses
  18. 18. Scanning the Future Results Locations of Ultrasound Machines AREA # OF MACHINESS Office 444 (38%) Breast Operating Room 306 (26%) Emergency Dept. 219 (19%) Acute Radiology Dept. 108 ( 8.9%) Laboratory 52 (4.3%) Other 46 (3.8) TOTAL = 1,175 (100%)
  19. 19. Scanning the Future Results 576 surgeons 386 restricted (67%) Where? Radiology = 55.4% Office = 4.7%
  20. 20. Scanning the Future Conclusions 1. Surgeons successfully use ultrasound and more than half do so in several clinical areas. 2. Many surgeons perform ultrasound-guided procedures, most commonly breast.
  21. 21. Scanning the Future Conclusions 3. In general, surgeons report competency with < 20 ultrasound examinations in most clinical areas, except Acute Setting Note: No difference if they performed ultrasound in >1 clinical area.
  22. 22. Scanning the Future “Acute Setting” Ultrasound Changes 1997: Trauma-related examinations Hemopericardium Hemoperitoneum Hemothorax
  23. 23. Scanning the Future “Acute Setting” Ultrasound Changes 2000: Trauma/Critical Care/Acute Gen. Surg. Hemopericardium Sternal Fracture Cholelithiasis Hemoperitoneum + AAA DVT Hemothorax Pneumothorax
  24. 24. Scanning the Future Conclusions 4. Surgeons have access to ultrasound machines in all patient care areas but, especially in the office and the operating room.
  25. 25. Scanning the Future Conclusions 5. There is widespread use of ultrasound by surgeons but, they are still restricted from using it in some patient care areas
  26. 26. Scanning the Future Discussion AIUM recommends: interpretation of 300 abdominal/general examinations But! Not applicable to surgeons because: !Surgeon has direct clinical contact with the patient. !Anatomy is enhanced by operative experience. !Examinations are focused: ask question/get answer. !Surgeons perform and interpret the examinations.
  27. 27. Scanning the Future Discussion Ownership of an ultrasound machine + the surgeon’s inquisitive mind: “How can I use ultrasound to help my patient?” !Encourages new uses of ultrasound !Portability allows access to all areas of patient care No department or specialty has ownership of this technology!
  28. 28. Scanning the Future Discussion The performance and interpretation of the examination with integration into the patient’s clinical picture underscore the need for the ultrasound examination to be performed by the surgeon who is caring for the patient.
  29. 29. Scanning the Future Recommendations for scanning the future… Expert surgeon-sonographers develop guidelines for competency in the each of the clinical areas
  30. 30. Scanning the Future Recommendations for scanning the future… The American College of Surgeons continue to be a major educational resource for surgeons interested in learning ultrasound

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