SCGH ED Clinician Performed Emergency Ultrasound Guidelines

These guidelines are designed to ensure the safety and quality of clinician performed emergency ultrasound in Australia.

Background

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.

Trainee (definition)

• 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

Practitioner (definition)

• 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)

Supervisor

• 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.

Trainees

Those who have completed an introductory course but not yet received accreditation for any one module may use the machine only if:

1. The patient consents to a training scan
2. They do not record any findings in the patient notes
3. Findings do not influence patient management unless independently  confirmed
4. 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.
5. 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

1. 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)
2. Cases must be recorded with an appropriate entry in the patient case notes.
3. Noteworthy case should ideally be recorded for logbooks, education and review.

Routes to ultrasound training

• In-house training
  • Ideal for peripheral vascular access teaching

• Basic Emergency Ultrasound training as per ACEM guidelines
  • for FAST / AAA / Vascular access (central)
  • Complete an accredited introductory ultrasound course – several options:
    • Ultrasound Village / Australian Institute of Ultrasound / Ultrasound Training Solutions / Emed Ultrasound
  • 25-50 supervised scans in each module
  • Competence-based assessment by certified supervisor
  • Maintenance of standards

• Certificate in Clinician Performed Ultrasound (CCPU)
  • Modular approach to clinician performed ultrasound run through ASUM
  • Similar process to basic emergency ultrasound
    • Complete a unit workshop (ie. AAA)
    • Keep logbook relevant to that unit (ie. AAA)
    • Have logbook reviewed and assessed as competent by a qualified assessor
  • Unit modules available include:
    • AAA / Vascular Access / EFAST / Biliary / Renal / Acute Scrotum / Basic Early Pregnancy / Basic Echo in Life Support etc…

• Diploma of Diagnostic Ultrasound (DDU)
  • Internationally accepted professional qualification certifying those specialist clinicans performing diagnostic ultrasound services
  • Currently the highest level of training available for clinicians in Australia
  • Need to have finished specialist medical training (i.e. FACEM)
  • Involves:
    • 2 years of supervised ultrasound imaging relevant to the specialty
    • Completion of a Casebook, Primary and Secondary examinations
  • Currently the DDU can be awarded in the following specialties:
    • General Ultrasound
    • Cardiology
    • Obstetrics and Gynaecology (O&G)
    • Vascular Studies
    • Critical Care (Intensive Care and Anaesthesia)
    • Emergency Medicine

• Other
  • There may be candidates who have trained outside these routes who through other accreditation processes may demonstrate sufficient experience to be accredited in Emergency Ultrasound. These cases are to be assessed on a case-by-case basis.