Point-of-Care Ultrasonography by Advanced Practice Providers for Patients With Undifferentiated Shock

Abstract

BACKGROUND: In this evidence-based practice project, point-of-care ultrasonography by advanced practice providers was implemented in a central Florida intensive care unit. The project was guided by the following question: Does implementation of point-of-care ultrasonography by critical care advanced practice providers over 3 months decrease time to intravenous fluid, vasopressor, or inotrope administration or modify the treatment plan for patients with undifferentiated shock, as compared with current practice without point-of-care ultrasonography? REVIEW OF EVIDENCE: A strong body of evidence supports using advanced practice provider-performed point-of-care ultrasonography to enhance care for critically ill patients. IMPLEMENTATION: Baseline data on treatment of patients with undifferentiated shock, including intravenous fluid volume and time to intervention, were collected over 60 days. Advanced practice providers then completed in-person point-of-care ultrasonography training focused on clinical application and integration into decision-making. A second 60-day data collection period tracked evaluation and treatment by advanced practice providers. EVALUATION: Time to intervention did not significantly differ between preintervention and postintervention groups. However, point-of-care ultrasonography findings consistently changed or refined patient care. SUSTAINABILITY: The project site will continue advanced practice provider-led point-of-care ultrasonography across all intensive care units. CONCLUSIONS: Implementation of point-of-care ultrasonography by critical care advanced practice providers does not delay intervention, helps confirm clinical diagnoses, and refines treatment delivery for patients with undifferentiated shock. Point-of-care ultrasonography provides a structured approach to assessment and management and should continue to be used in intensive care units.