BE-SAFE: Bedside Sonography for the Assessment of the Fetus in Emergencies. Effect of an Educational Intervention on Emergency Physician Ability to Perform a Focused Late Pregnancy Obstetric Ultrasound Video


Introduction: Late obstetric emergencies are time critical presentations in the emergency department
(ED). 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.
Subjects were a convenience sample of EP attendings (N=17) and residents (N=14). Prior to the
educational intervention of ultrasound training, participants completed a self-assessment survey on
their confidence, and knowledge pre-test. After training, we recorded subjects’ time and accuracy of
performance of FHR, EGA, and fetal lie. Post-intervention knowledge tests and confidence surveys
were administered. We compared results 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 [1] 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.
Conclusion: After a focused POC OBUS training intervention, EPs can accurately and rapidly use
ultrasound to determine FHR, fetal lie, and estimate gestational age in mid-late pregnancy.