The Society of Hospital Medicine (SHM) recently issued a position statement on how hospitalists should be credentialed to perform ultrasound-guided bedside procedures.
A panel of experts conducted a systematic review before developing recommendations for credentialing related to six ultrasound-guided procedures: abdominal paracentesis, arterial catheter placement, arthrocentesis, central venous catheter placement, lumbar puncture, and thoracentesis. Their 16 recommendations, based on expert opinion, were published online by the Journal of Hospital Medicine on Jan. 18 and are as follows:
- Basic cognitive competence can be certified with written or oral examinations.
- Minimum thresholds of experience to trigger the timing of a patient-based assessment should be determined by empirical methods.
- Hospitalists should formally log all of their attempted procedures, ideally in an electronic medical record.
- Health information technology service should routinely pull collations of all attempted procedures from comprehensive electronic medical records.
- Basic manual competence must be certified through patient-based assessments.
- Certification assessments of manual competence should combine two types of structured instruments: checklists and overall scores.
- Certification assessments should include feedback.
- If remedial training is needed, simulator-based training can supplement but not replace patient-based training.
- A minimum threshold of experience should be reached before patient-based assessments are conducted.
- Initial certification assessments should ideally begin on simulators.
- Certification to perform ultrasound-guided procedures should be routinely re-evaluated during ongoing credentialing.
- Observed patient-based assessments should occur when a periprocedural safety event occurs that is potentially caused by “provider error.”
- Simulation-based practice can supplement patient-based experience for ongoing credentialing.
- Hospitalists themselves should not bear the financial costs of developing and maintaining training and certification programs for ultrasound-guided procedures.
- Assessors should be unbiased expert providers who have demonstrated mastery in performance of the procedure being assessed and regularly perform it in a similar practice environment.
- If intramural assessors are not available, extramural assessors may be considered.