Page 112 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

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Chapter 4
Discussion
In this study, we mapped the factors influencing the experience, confidence and practical application of emergency US. Every EP valued the use of US and it was described to be an indispensable tool in daily practice. They were highly motivated to use their new skills. This is in concordance with the results of Heinzow et al. who interviewed a group of medical students before and immediately after a basic ultrasound course and also found them to be highly motivated to apply the newly acquired US skills in daily practice.21
In the Netherlands, no guidelines exist on the implementation of EP-performed emergency US on the ED. Every ED has the responsibility to assign specific (US) qualifications to the in- dividual physicians. EDs in the United States, however, adhere to the Ultrasound Guidelines, developed by the American College of Emergency Physicians (ACEP).22 These guidelines are helpful starting an emergency US program and provide recommendations for proper im- plementation of emergency ultrasound on the ED, including a minimum number of clinical training hours.
The cooperation with the radiology department appeared to be very agreeable in some hos- pitals, while in others, tensions were reported. Participants indicated that radiologists them- selves, rightly or wrongly, were concerned about the quality of EP-performed US examina- tions. Therefore, we would recommend the development of national guidelines comparable to the ACEP.
This study shows that there is a need for a quality assurance system for US skills. The purpose of such a system may be to keep a record of every EPs knowledge and skills. It might consist of course certificates and a collection of stored US images or video clips demonstrably super- vised by radiologists or expert colleagues. In one hospital, a lack of quality assurance resulted in mandatory verification of every US examination by a radiologist. In another, EPs are sim- ply relying on the skills of their colleagues. Meanwhile, a Dutch US certification program for EPs has been adopted by the general assembly of the NVSHA in June 2017.
US training has recently become a compulsory item in the residents’ curriculum. It is es- sential to remain confident with the PREP protocol and US images. Therefore, it is advised to schedule regular practice to improve on speed, accuracy, and recognition of negative US images in healthy subjects. Regular practice should be part of the quality assurance system.
Budhram reported an effective emergency US training program for EPs, including eFAST. The participant’s goal was to complete and record 25 technically adequate eFAST studies