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

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?

A strong body of evidence supports using advanced practice provider-performed point-of-care ultrasonography to enhance care for critically ill patients.

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.

Time to intervention did not significantly differ between preintervention and postintervention groups. However, point-of-care ultrasonography findings consistently changed or refined patient care.

The project site will continue advanced practice provider-led point-of-care ultrasonography across all intensive care units.

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.