SCGH ED Clinician Performed Emergency Ultrasound Guidelines are a MUST READ if performing ultrasound examination within SCGH ED. These guidelines contain information on levels of ultrasound training, routes of ultrasound training, aswell as appropriate communication with staff and patients and use of the ultrasound machines.
Note: Those performing ultrasound examinations within SCGH ED should communicate your level of ultrasound training with both staff and patients to allow appropriate interpretation of your report / opinion into the patients assessment.
These guidelines are designed to ensure the safety and quality of clinician performed emergency ultrasound in Australia.
The Australasian College of Emergency Medicine (ACEM) and The Australasian Society for Ultrasound in Medicine (ASUM) as well as emergency physicians realise the potential benefit of the use of ultrasound in the emergency setting. Ultrasound however is user dependent and adequate training, experience and understanding is paramount in ensuring its safe implementation into our practice.
Levels of Training
It is recognised that there are levels of training and expertise in clinician-performed ultrasound. It is also acknowledged that ultrasound can be useful even to those with less training for specific indications.
Essential components for safe and appropriate use of ultrasound in Emergency include:
- All clinicians who use the ultrasound machine have successfully met minimum training standards.
- Those with limited modular training use ultrasound only for the focussed area in which they have been trained.
- Those with more advanced training should be allowed to use ultrasound within the scope of their practice as appropriate to their training.
- Images and reports are recorded to ensure adequate communication with other clinicians involved in patient care and for quality assurance, training, audit and safety purposes.
- Has completed an introductory course, but is not yet accredited to perform independent ultrasound examinations, nor allow ultrasound to influence patient management without independent confirmation of their findings.
- All scans go towards logbook and accreditation only
- Has completed introductory course and is accredited to perform ultrasound within the scope(s) of practice described by the module(s) which have been completed.
- Is not able to supervise trainees
- Should compare all scans with gold standard investigations where possible as a means to quality assurance
- (Note that a clinician may be a trainee within one module’s scope of practice and a practitioner within a different module scope of practice)
- Certificate in Clinician Performed Ultrasound (CCPU) or Diploma in Diagnostic Ultrasound (DDU) (or equivalent) qualified
- Qualified to supervise trainees
- Ideally involved in teaching, audit, quality improvement and research projects
Use of the Ultrasound machine
The ultrasound machine should not be used by anyone who has not completed at least an accredited introductory ultrasound course, unless supervised by an ultrasound trained clinician.
Those who have completed an introductory course but not yet received accreditation for any one module may use the machine only if:
- The patient consents to a training scan
- They do not record any findings in the patient notes
- Findings do not influence patient management unless independently confirmed
- All scans are recorded in the trainee’s logbook and are recorded with appropriate images and labelling for review and quality assurance at a later time.
- Ultrasound guided peripheral vascular access is a low risk ultrasound procedure and a formal logbook is not required. An introductory course (which may be encompassed in routine departmental teaching) should be all that is required. This would include information on technique as well as machine care.
Those who have Practitioner or Supervisor accreditation
- May use ultrasound within their recognised scope of practice. (Note that a clinician may be a trainee within one module’s scope of practice and a practitioner within a different module’s scope of practice)
- Cases must be recorded with an appropriate entry in the patient case notes.
- Noteworthy case should ideally be recorded for logbooks, education and review.
Routes to ultrasound training
- In-house training
- Ideal for peripheral vascular access teaching
Date implemented – 1/2008
Review date – review pending
Author – James Rippey