Simulation-Based Cardiac Point-of-Care Ultrasound Program to Improve Clinical Outcomes in Acute Heart Failure Patients

Cardiac disease is the leading cause of mortality worldwide, with over 6.7 million Americans with acute heart failure (AHF) presenting with 1 million annual emergency department (ED) visits. Point-of-care ultrasound (POCUS) is a critical bedside tool that can expedite diagnosis and treatment in AHF patients. However, gaps in POCUS training remain that limit clinical utilization. Simulation-based training reinforces technical skills for clinical application. Prior work achieved high procedural knowledge (70% passed, 18% SD) and technical skills (95%, 6% SD) in emergency medicine (EM) clinicians using a simulation nerve block model, with retention at 3-months post-intervention. The current proposed study builds on this work, using the Implementation Research Longitudinal Framework (IRLM) to translate knowledge into clinical skills through simulation-based POCUS training for EM physicians and Advanced Practice Providers (APPs) to improve time-to-diuretics and AHF patient clinical outcomes. Specific Aim 1 uses adaptive Experience-Based Co-design (EBCD) to co-design a cardiac POCUS simulation training intervention and implementation strategy for EM clinicians The cardiac POCUS training workshop and reinforcement sessions will be co-designed with ED leadership, ultrasound faculty, and key stakeholders. Participants will then perform cardiac and lung POCUS using standardized clinical practice guidelines (CPG) in AHF patients as part of clinical care. Specific Aim 2 is the intervention assessment. We will assess pre-, post, and 6-month post-simulation participant POCUS skills using validated ultrasound self-efficacy scales, image interpretation tests (knowledge), and simulated scenario performance (technical skills). Specific Aim 3 evaluates the effectiveness of the cardiac POCUS simulation-based training and clinical practice guideline implementation. The investigators will perform a quasi-experimental pre-/post design by interrupted time series with one year of data before and after intervention implementation. We will perform a quasi-experimental pre-/post design interrupted time series with one year of data before and after intervention implementation in three diverse EDs. Our primary clinical outcome is time-to-diuretic dose in ED heart failure patients.11 PROCTOR-guided outcomes include effectiveness, provider adoption, and clinical POCUS uptake/utilization.

• Acceptability of the Intervention as measured by the Acceptability of Intervention Measure (AIM) [Time frame: up to 6 months post-workshop]
• Appropriateness of the Intervention as measured by the Intervention Appropriateness Measure (IAM) [Time frame: up to 6 months post-workshop]
• Feasibility of the Intervention as measured by the Feasibility of Intervention Measure (FIM) survey tool [Time frame: up to 6 months post-workshop]
• Feasibility of implementing a cardiac point-of-care ultrasound (POCUS) simulation training and clinical practice guidelines for physicians and advanced practice providers (APPs) [Time frame: 12 months pre and 12 months post-intervention]
• Effectiveness of the simulation-based cardiac POCUS training implementation as measured by the number of clinical POCUS performed in the ED [Time frame: 12 months pre and 12 months post-intervention]
• Effectiveness of the simulation-based cardiac POCUS training implementation as measured by image quality review scores [Time frame: 12 months pre and 12 months post-intervention]
• Clinical impact of the training model on point-of-care ultrasound (POCUS) use and diagnostic performance as measured by the time to initial cardiology consult [Time frame: 12 months pre and 12 months post-intervention]
• Clinical impact of the training model on point-of-care ultrasound (POCUS) use and diagnostic performance as measured by emergency department length-of-stay [Time frame: 12 months pre and 12 months post-intervention]
• Clinical impact of the training model on heart failure patients as measured by the number of participants with serious cardiac outcomes [Time frame: 12 months pre and 12 months post-intervention]
• Ultrasound Self-efficacy Scale [Time frame: 6 months]
• Provider adoption as measured by the number of cardiac/lung POCUS exams performed by each participant for ED acute heart failure patients [Time frame: 12 months pre and 12 months post-intervention]
• Ultrasound image interpretation test [Time frame: 6 months]