The Rural Obstetrical Ultrasound Triage Exam (ROUTE): Teaching Health Care Workers in International Settings [392]

Abstract

INTRODUCTION: This pilot study was designed to assess the feasibility of training inexperienced rural healthcare workers to use the Rural Obstetrical Ultrasound Triage Exam (ROUTE). The ROUTE is a diagnostic algorithm using portable ultrasound in rural areas to triage patients for future risk of maternal or fetal complications. METHODS: Participant attitude and experience in obstetrical ultrasound (OB-US) was assessed using a twenty-item survey pre-and post-course. Medical students who completed a yearlong ultrasound program and twelve hours of OB-US training, taught participants two-hours of basic ultrasound and the ROUTE with six hours of hands-on training. Participants then performed ROUTE scans on patients. Practical skills were compared to trained student controls. RESULTS: OB-US knowledge improved from a pre-course average of 31.31% to 70.71% (n=12) correct post-course; a two-tailed paired t-test comparing tests was significant (P=.0002). In all surveys, participants identified OB-US as “safe” and the technology as useful to their healthcare practice. Participants assessed fetal number (n=26) and fetal presentation (n=10) on 100% of scans (0% error). Placenta previa (n=25) and oligohydramnios/polyhydramnios (n=8) were correctly ruled out on 100% of scans (0% error). On average, participants correctly dated pregnancies based on CRL (n=7) 57.1% of the time, and BPD (n=10) 61.1% of the time (<7% error) compared to controls. CONCLUSION: This pilot study found that with medical student-led ROUTE training, it is possible to teach rural healthcare workers how to successfully perform many important aspects of the ROUTE. Additionally, these results highlight a need for more robust training for accurate fetal dating.