Page 113 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars
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                 Implementing ultrasound in Dutch emergency departments after a two-day training 111
on their EDs. To record the knowledge and skills on every participant’s ED, and for quality assurance, an on-site archiving system was put in place.23 They also observed the turf battles: the radiology department questioned the EP’s competency and they feared a reduction in their department’s study volumes.
Strength and Limitations
This study yields new information about the experiences of Dutch EPs running a US proto- col in practice. We gained insight in the role of Dutch EPs on their EDs, their collaboration with colleagues, the varying levels of confidence, and the need for a quality assurance system. Because we used open-ended questions, new topics emerged that complemented the initial topic list.
A limitation of the study is that one researcher coded the transcripts. This might impact the reliability of coding. Furthermore, this study is limited in its scope by including a homoge- nous group of EPs employed by Level 2 hospitals only. Also including EPs from Level 1 and 3 hospitals, might have produced a more complete overview.
To successfully implement US, EPs should focus on the development of a quality assurance system. However, it remains unclear whether a uniform (national) system is preferred or departments prefer to develop their own system.
Furthermore, emergency ultrasound should be defined more clearly to benefit accreditation and uniformity. The ACEP Ultrasound Guidelines include a list of basic US applications considered part of emergency ultrasound.22

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