Thomas E Robertson1, Andrea R Levine2, Avelino C Verceles3, Jessica A Buchner3, James H Lantry4, Alfred Papali5, Marc T Zubrow6, L Nathalie Colas7, Marc E Augustin7, Michael T McCurdy8. 1. Department of Medicine, University of Pittsburgh Medical Center, 200 N Lothrop St, Montefiore N715, Pittsburgh, PA 15213, United States. 2. Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, 628 NW, Pittsburgh, PA 15213, United States. 3. Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD 21201, United States. 4. Uniform Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States. 5. Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD 21201, United States; Institute for Global Health, University of Maryland School of Medicine, 685 W. Baltimore Street, Baltimore, MD 21201, United States. 6. Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD 21201, United States; Program in Trauma, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, United States; University of Maryland eCare, University of Maryland Medical System, 110 S. Paca St., 5th Floor, Baltimore, MD 21201, United States. 7. Department of Medicine, St. Luke Family Hospital, Port-au-Prince, Haiti. 8. Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD 21201, United States; University of Maryland School of Medicine, Department of Emergency Medicine, 110 S. Paca St., 6th Floor, Baltimore, MD 21201, United States. Electronic address: mmccurdy@som.umaryland.edu.
Abstract
PURPOSE: Ultrasound (US) is a burgeoning diagnostic tool and is often the only available imaging modality in low- and middle-income countries (LMICs). However, bedside providers often lack training to acquire or interpret US images. We conducted a study to determine if a remote tele-intensivist could mentor geographically removed LMIC providers to obtain quality and clinically useful US images. MATERIALS AND METHODS: Nine Haitian non-physician health care workers received a 20-minute training on basic US techniques. A volunteer was connected to an intensivist located in the USA via FaceTime. The intensivist remotely instructed the non-physicians to ultrasound five anatomic sites. The tele-intensivist evaluated the image quality and clinical utility of performing tele-ultrasound in a LMIC. RESULTS: The intensivist agreed (defined as "agree" or "strongly agree" on a five-point Likert scale) that 90% (57/63) of the FaceTime images were high quality. The intensivist felt comfortable making clinical decisions using FaceTime images 89% (56/63) of the time. CONCLUSIONS: Non-physicians can feasibly obtain high-quality and clinically relevant US images using video chat software in LMICs. Commercially available software can connect providers in institutions in LMICs to geographically removed intensivists at a relatively low cost and without the need for extensive training of local providers.
PURPOSE: Ultrasound (US) is a burgeoning diagnostic tool and is often the only available imaging modality in low- and middle-income countries (LMICs). However, bedside providers often lack training to acquire or interpret US images. We conducted a study to determine if a remote tele-intensivist could mentor geographically removed LMIC providers to obtain quality and clinically useful US images. MATERIALS AND METHODS: Nine Haitian non-physician health care workers received a 20-minute training on basic US techniques. A volunteer was connected to an intensivist located in the USA via FaceTime. The intensivist remotely instructed the non-physicians to ultrasound five anatomic sites. The tele-intensivist evaluated the image quality and clinical utility of performing tele-ultrasound in a LMIC. RESULTS: The intensivist agreed (defined as "agree" or "strongly agree" on a five-point Likert scale) that 90% (57/63) of the FaceTime images were high quality. The intensivist felt comfortable making clinical decisions using FaceTime images 89% (56/63) of the time. CONCLUSIONS: Non-physicians can feasibly obtain high-quality and clinically relevant US images using video chat software in LMICs. Commercially available software can connect providers in institutions in LMICs to geographically removed intensivists at a relatively low cost and without the need for extensive training of local providers.
Authors: Jason Stankiewicz; Maniraj Jeyaraju; Andrew R Deitchman; Avelino C Verceles; Alison Grazioli; Michael T McCurdy Journal: ATS Sch Date: 2021-11-30
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