title: BE-SAFE: Bedside sonography for assessment of the fetus in emergencies: educational intervention for late-pregnancy obstetric ultrasound.
abstract: BACKGROUND
  Late obstetric emergencies are time critical presentations in the emergency department. Evaluation to ensure the safety of mother and child includes rapid assessment of fetal viability, fetal heart rate (FHR), fetal lie, and estimated gestational age (EGA). Point-of-care (POC) obstetric ultrasound (OBUS) offers the advantage of being able to provide all these measurements. We studied the impact of POC OBUS training on emergency physician (EP) confidence, knowledge, and OBUS skill performance on a live model.
  
  
  METHODS
  This is a prospective observational study evaluating an educational intervention we designed, called the BE-SAFE curriculum (BEdside Sonography for the Assessment of the Fetus in Emergencies). Subjects were a convenience sample of EP attendings (N=17) and residents (N=14). Prior to the educational intervention, participants completed a self-assessment survey on their confidence regarding OBUS, and took a pre-test to assess their baseline knowledge of OBUS. They then completed a 3-hour training session consisting of didactic and hands-on education in OBUS. After training, each subject's time and accuracy of performance of FHR, EGA, and fetal lie was recorded. Post-intervention knowledge tests and confidence surveys were administered. Results were compared with non-parametric t-tests.
  
  
  RESULTS
  Pre- and post-test knowledge assessment scores for previously untrained EPs improved from 65.7% [SD=20.8] to 90% [SD=8.2] (p<0.0007). Self-confidence on a scale of 1-6 improved significantly for identification of FHR, fetal lie, and EGA. After training, the average times for completion of OBUS critical skills were as follows: cardiac activity (9s), FHR (68.6s), fetal lie (28.1s), and EGA (158.1 sec). EGA estimates averaged 28w0d (25w0d-30w6d) for the model's true gestational age of 27w0d.
  
  
  CONCLUSIONS
  After a focused POC OBUS training intervention, the BE-SAFE educational intervention, EPs can accurately and rapidly use ultrasound to determine FHR, fetal lie, and estimate gestational age in mid-late pregnancy.
authors.affiliation: University of Washington School of Medicine, Division of Emergency Medicine, Seattle, Washington.
authors.forename: Sachita
authors.initials: S
authors.lastname: Shah
authors.affiliation: University of Washington School of Medicine, Division of Emergency Medicine, Seattle, Washington.
authors.forename: Adeyinka
authors.initials: A
authors.lastname: Adedipe
authors.affiliation: University of Arizona, Department of Emergency Medicine, Tuscon, Arizona.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Ruffatto
authors.affiliation: University of Washington School of Medicine, Division of Emergency Medicine, Seattle, Washington.
authors.forename: Brandon H
authors.initials: BH
authors.lastname: Backlund
authors.affiliation: Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Dana
authors.initials: D
authors.lastname: Sajed
authors.affiliation: University of Washington School of Medicine, Division of Emergency Medicine, Seattle, Washington.
authors.forename: Kari
authors.initials: K
authors.lastname: Rood
authors.affiliation: University of Washington School of Medicine, Division of Emergency Medicine, Seattle, Washington.
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Fernandez
mesh_terms: D002983:Clinical Competence; D004521:Educational Measurement; D004636:Emergency Service, Hospital; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006801:Humans; D009774:Obstetrics / Q000193:education* / Q000295:instrumentation; D019095:Point-of-Care Systems; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging*; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D014463:Ultrasonography