A Cohort Study to Evaluate Emergency Medicine Ultrasound by Non-Sonographers in Clinical Practice

Abstract

Previous research has evaluated the sensitivity and specificity of emergency medicine ultrasound (EMU); however, the literature on clinical governance issues such as the quality of training, competence of the operator, development of clinical guidelines or standard setting within individual trusts is very limited. Although national guidelines have been issued regarding governance of non-radiology performed ultrasound, it is unclear whether the expectations provided within the guidance are being implemented in clinical practice. The aim of this study was to explore the clinical governance and service provision of emergency medicine practitioners who had attended a two-day formal training course on EMU. The method used was a prospective non-randomized study using an electronic questionnaire to 160 clinicians who had attended a two-day EMU course. The questions investigated the clinicians’ EMU clinical practice in their departments including profession, grade, number of scans, types of examinations, equipment used and clinical governance arrangements such as scope of practice, audit, guidelines, support, archiving of reports and images. Responses were obtained from 59 of 160 (37%) delegates. The mean time they had been involved in emergency medicine was 8.31 years. Most (73%) were performing EMU in their current roles. Nearly all (86%) felt that the two-day course had given them adequate training and over half were performing extra examinations to those taught on the course. Only 23 (39%) respondents had supervision in their workplace after the course. Less than half (46%) were aware of national EMU guidelines, and only 22% of respondents indicated there were local clinical guidelines in place. A significant proportion of departments (37%) do not undertake audit. In conclusion, most of the respondents were not aware of the national guidelines around EMU and there was a lack of evidence that clinical governance issues were being enforced by all trusts. Many departments showed a limited use of clinical guidelines, audit regimes or competency assessment.