In the second semester of their three-year doctoral program at the University of Miami School of Nursing and Health Studies, Christopher Lay, RN, and Emma Mullen, RN, took a course called Advanced Diagnostic Reasoning for Nurse Anesthesia Practice and never looked back. “We took the information we learned that semester and ran with it,” they said, inspired to explore how ultrasound could make preoperative assessments safer for patients.
Set to graduate from the B.S.N.-D.N.P. Nurse Anesthesia program this December, the pair present “Performing and Educating on Gastric Ultrasound Using the I‑AIM Framework,” at eMerge Americas on Friday, April 24, from 2-2:30pm. Billed as “Miami’s global tech summit,” eMerge is a venture-backed platform and annual technology event held at the Miami Beach Convention Center.
“We are honored to represent University of Miami at eMerge,” said Lay and Mullen. “Point-of-care gastric ultrasound is a technology currently available for anesthesia providers, but there is no standardized education surrounding incorporation in clinical practice. We hope to share our excitement and passion surrounding gastric ultrasound by highlighting the work we have done during our time in the University of Miami Nurse Anesthesia program.”
Is fasting enough?
One important issue addressed in their scholarship is the fasting component required for most surgical procedures with anesthesia. “No food or drink after midnight” is a common pre-op instruction, but is following this rule enough to ensure safety for all surgical patients?
“Despite following recommended fasting guidelines, there are multiple risk factors for delayed gastric emptying that may pre-dispose patients to perioperative aspiration when they undergo anesthesia,” said Lay and Mullen. “Some of these risk factors include diabetes mellitus, gastroesophageal reflux disease, and currently popular GLP-1 receptor agonist medications like Ozempic, Wegovy, Trulicity, and Mounjaro.”
Although the advanced diagnostics course they took covered ultrasound use for cardiac, lung, airway and other conditions, Lay and Mullen decided to focus their research on gastric ultrasound after seeing the amount of literature discussing its potential for reducing surgery-related anesthesia complications. Each student also gained firsthand knowledge by completing separate scholarly projects on gastric ultrasound at two different Miami-area hospitals.
“We can take an ultrasound machine, put it on someone’s abdomen and within a few seconds know if we have to alter our anesthetic plan to make a patient safer,” they explained.
Standardize education
Lay and Mullen are using what they’ve learned the past two years to advocate for the kind of standardized ultrasound education they received at the School of Nursing and Health Studies in NUR 618.
“We did not find another nurse anesthesia course like it through our research,” they said. “Research conducted during our initial D.N.P. coursework led us to realize there is no standardization for ultrasound education among anesthesia providers. This seems to be a big part of why it is not commonly used. Incorporation into nurse anesthesia curricula is relatively new over the last few years. To make this a useful tool for current and future anesthesia providers, we need to find a way to standardize education.”
Their interest in this issue compelled them to develop and complete a research project to assess the efficacy of the NUR 618 diagnostics course in improving novice anesthesia provider knowledge on gastric ultrasound.
Based on their study findings, one tool they propose to achieve this goal is the “I-AIM” (indications, image acquisition, image interpretation, and medical decision-making” framework, which is designed to cover all necessary components of the diagnostic ultrasound evaluation.
“This framework is recommended but not currently a standard of practice in education,” they said. “We hope sharing the information we learned from this doctoral work, we can add to current literature and potentially create standardized education for gastric ultrasound, thereby supporting the transition of gastric ultrasound from optional skill to standard of care.”
Supportive faculty
“We are very proud of our students’ achievements, as they reflect the strength of our students, faculty mentorship, and the innovative clinical scholarship within our Nurse Anesthesia program,” said Greta Mitzova-Vladinov, director of the Nurse Anesthesia program.
Lay and Mullen credit their School of Nursing and Health Studies mentors for nurturing their intellectual curiosity and guiding them through the complex University institutional review board (IRB) approval process for their research project.
“Dr. Hauglum supported us and always has challenged us to be the best versions of ourselves,” they said of former school member and alumnus Shayne Hauglum, instructor of the inaugural cohort of NUR618 in 2024. “He was the first person to introduce us to the endless possibilities of point-of-care ultrasound and continues to advocate for portable ultrasound being the ‘stethoscope of the future.’”
Faculty member Andres Ocampo-Salazar, M.D., gave them “continued support through the project design and data collection periods of our study,” added Mullen and Lay.
Finally, it was their faculty mentor Nicole Gonzaga-Gomez, assistant director of the Nurse Anesthesia program, who encouraged them apply to present at eMerge. “Dr. Gonzaga-Gomez is a champion and advocate for students, and we are so grateful to be part of a program that is supportive of our work and interests,” they said.
Lay and Mullen hope their eMerge appearance will help fellow students, faculty, health care providers and patients alike. “We both share a similar passion for how current technology can be used to make anesthesia safer for patients,” they said. “Ultrasound is not a new technology, but education and incorporation into anesthesia training is, and we want to try and help spread the word any way we can.”
