Point of Care Ultrasound for Critical Care Advanced Practice Providers: Meeting a Critical Standard of Care at the University of Cincinnati Medical Center

Kelly Rath, ACNP
Lead Nurse Practitioner, Department of Neurocritical Care
Lori A. Stolz MD, RDMS, FACEP
Associate Professor of Emergency Medicine, Director of Emergency Ultrasound
Jordan Bonomo MD, FCCM, FNCS
Associate Professor of Emergency Medicine, Neurosurgery/Neurocritical Care, Neurology
Director for Neurocritical Care Fellowship at the University of Cincinnati
Director for Emergency Medicine Critical Care Division

Advanced practice providers (APPs) are a growing part of the critical care team and play a crucial role in the care of approximately 6 million patients admitted to intensive care units annually [1]. Multiple studies support the quality care that advanced practice provide in these settings [2] and it is imperative that APPs continue to meet standards of care in these settings. This includes staying up-to-date on technology guiding practice change.

Point-of-care ultrasound (POCUS) allows for real-time patient evaluation in a focused way, and has become a widely-accepted tool in the critical care and emergency settings. POCUS is now considered a standard of care in these settings [3,4,5,6]. Multiple societies including the American College of Emergency Physicians (ACEP) and the Society of Critical Care Medicine (SCCM) support the training needs of APPs. ACEP has created guidelines for the integration of POCUS by APPs [7].

The University of Cincinnati Medical Center recognizes the crucial role that APPs play in the management of critically-ill patients, and has put forth a substantial effort to ensure that the institution’s APPs are meeting this crucial standard of care. The hospital’s System-Wide POCUS Committee developed a unique protocol offering APPs the ability to formally train and become credentialed to perform POCUS studies. This initiative has been spearheaded by Dr. Jordan Bonomo, associate professor of Emergency Medicine and Neurocritical Care, Dr. Lori Stolz, the Director of Emergency Ultrasound and Associate Professor of Emergency Medicine, Dr. Kathleen Ballman, associate professor of clinical nursing at the UC College of Nursing, and Kelly Rath, lead nurse practitioner in the Department of Neurocritical Care, along with assistance from physicians in multiple departments. The formal credentialing, training, and QA process is currently under review by the hospital’s Credentialing Committee.

 This is one of the few formalized training initiatives for APPs throughout the nation and is a testament to the cutting-edge care that is provided by the University of Cincinnati’s teams of physicians and advanced practice providers. The goal is to continue to remain at the leading edge of technologies, such as POCUS, to ensure the highest quality care for patients.

REFERENCES

[1] Halpern, N.A., Goldman, D.A., Tan, K.S., & Pastores, S.M. (2016). Trends in critical care beds and use among population groups and Medicare and Medicaid beneficiaries in the United States: 2000-2010. Critical Care Medicine, 44(8), 1490-1499. https://doi.org/10.1097/CCM.0000000000001722

[2] Kleinpell, R.M., Grabenkort, W.R., Kapu, A.N., Constantine, R., & Sicoutris, C. (2019). Nurse practitioners and physician assistants in acute and critical care: A concise review of the literature and data 2008-2019. Critical Care Medicine, 47(10), 1442-1449.

[3] American College of Emergency Physicians (2016). Ultrasound Guidelines: Emergency, Point-of-care, and Clinical Ultrasound Guidelines in Medicine. https://www.acep.org/patient-care/policy-statements/ultrasound-guidelines-emergency-point-of--care-and-clinical-ultrasound-guidelines-in-medicine/

[4] Frankel, H.L., Kirkpatrick, A.W., Elbarbary, M., Blaivas, M., Desai, H., Evans, D., Summerfield, D.T., Slonim, A., Breitkreutz, R., Price, S., Marik, P.E., Talmor, D., & Levitov, A. (2015). Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients- Part I: general ultrasonography. Critical Care Medicine, 43(11), 2479-2502

[5] Levitov, A., Frankel, H. L., Blaivas, M., Kirkpatrick, A. W., Su, E., Evans, D., Elbarbary, M. (2016). Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill Patients -Part II: cardiac ultrasonography. Critical Care Medicine, 44(6), 1206-1227. https://doi.org/ 10.1097/CCM.0000000000001847.

[6] Vieillard-Baron, A., Millington, S.J., Sanfilippo, F., Chew, M., Diaz-Gomez, J., McLean, A., Pinsky, M.R., Pulido, J., Mayo, P., & Fletcher, N. (2019). A decade of progress in critical care echocardiography: a narrative review. Intensive Care Medicine, 45, 770-788. https://doi.org/10.1007/s00134-019-05604-2

[7] American College of Emergency Physicians (2019). Advanced Practice Provider Point-of-Care Ultrasound Guidelines.  https://www.acep.org/patient-care/policy-statements/advanced-practice-provider-point-of-care-ultrasound-guidelines2/