Ultrasonography

Acoustic Times or . . . Scan you believe it! - A quality publication. Ultrasound governance: communicating standards during a pandemic (2023)

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Type of publication:Conference abstract

Author(s):*Brown H.

Citation:Ultrasound. Conference: 53rd Annual Scientific Meeting of the British Medical Ultrasound Society. Cardiff United Kingdom. 31(2) (pp NP32), 2023. Date of Publication: May 2023.

Abstract:Introducing new governance processes into a multisite ultrasound department during a pandemic led to the re-thinking of the models of communication used to share governance objectives. The introduction of peer review audit can be challenging for staff. Clear communication is vital to ensure staff are not threatened by the process and are able to use it as a learning opportunity to shape their practice and development, thereby improving patient safety. A monthly newsletter Acoustic Times was introduced to explain the processes and changes giving the opportunity to provide the evidence base and links to national guidance. Peer review audit and learning meetings were introduced and held virtually across sites to identify and share any individual or group learning points. Processes and documents were either redesigned or introduced, with supporting rationale and evidence provided through the newsletter including: evidence based protocols; standard setting; peer review audit, including supporting learning outcomes and CPD; actionable reporting; preceptorship; service user feedback; and equipment QA. Further supported learning was provided on critical reflection, specific focus on technical aspects of clinical examinations, sharing of external learning events, CPD and inhouse ultrasound training. Benefits of the newsletter include: more focus on improving consistency of practice and setting standards; faster reporting of audit findings and reaudits; and improved engagement with consultant colleagues. It also provides an accessible record of the development of governance processes which has been shared with sonographers in other organisations. Setting and communicating clearly defined quality standards and protocols is key to the design of safe working practices and patient safety in healthcare environments.1 Open and honest governance processes with clear, accessible and useable documentation are key in staff engagement and ownership of quality improvement.

Focused transoesophageal TOE (fTOE): A new accreditation pathway (2023)

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Type of publication:
Journal article

Author(s):
Rubino A.; Peck M.; *Miller A.; Edmiston T.; Klein A.A.; Orme R.; Sankar V.; Fletcher N.; O'Keeffe N.; Skinner H.

Citation:
Journal of the Intensive Care Society. Date of Publication: 2023. [epub ahead of print]

Abstract:
The concept of a focused ultrasound study to identify sources of haemodynamic instability has revolutionized patient care. Point-of-care ultrasound (POCUS) using transthoracic scanning protocols, such as FUSIC Heart, has empowered non-cardiologists to rapidly identify and treat the major causes of haemodynamic instability. There are, however, circumstances when a transoesphageal, rather than transthoracic approach, may be preferrable. Due to the close anatomical proximity between the oesophagus, stomach and heart, a transoesphageal echocardiogram (TOE) can potentially overcome many of the limitations encountered in patients with poor transthoracic ultrasound windows. These are typically patients with severe obesity, chest wall injuries, inability to lie in the left lateral decubitus position and those receiving high levels of positive airway pressure. In 2022, to provide all acute care practitioners with the opportunity to acquire competency in focused TOE, the Intensive Care Society (ICS) and Association of Anaesthetists (AA) launched a new accreditation pathway, known as Focused Transoesophageal Echo (fTOE). The aim of fTOE is to provide the practitioner with the necessary information to identify the aetiology of haemodynamic instability. Focused TOE can be taught in a shorter period of time than comprehensive and teaching programmes are achievable with support from cardiothoracic anaesthetists, intensivists and cardiologists. Registration for fTOE accreditation requires registration via the ICS website. Learning material include theoretical modules, clinical cases and multiple-choice questions. Fifty fTOE examinations are required for the logbook, and these must cover a range of pathology, including ventricular dysfunction, pericardial effusion, tamponade, pleural effusion and low preload. The final practical assessment may be undertaken when the supervisors deem the candidate's knowledge and skills consistent with that required for independent practice. After the practitioner has been accredited in fTOE, they must maintain knowledge and competence through relevant continuing medical education. Accreditation in fTOE represents a joint venture between the ICS and AA and is endorsed by Association of Cardiothoracic Anaesthesia and Critical care (ACTACC). The process is led by TOE experts, and represents a valuable expansion in the armamentarium of acute care practitioners to assess haemodynamically unstable patients.

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FUSIC HD. Comprehensive haemodynamic assessment with ultrasound (2022)

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Type of publication:
Journal article

Author(s):
*Miller A.; Peck M.; Clark T.; Conway H.; Olusanya S.; Fletcher N.; Aron J.; Coleman N.; Parulekar P.; Kirk-Bayley J.; Wilkinson J.N.; Wong A.; Stephens J.; Rubino A.; Attwood B.; Walden A.; Breen A.; Waraich M.; Nix C.; Hayward S.

Citation:
Journal of the Intensive Care Society. 23(3) (pp 325-333), 2022. Date of Publication: August 2022.

Abstract:
FUSIC haemodynamics (HD) – the latest Focused Ultrasound in Intensive Care (FUSIC) module created by the Intensive Care Society (ICS) – describes a complete haemodynamic assessment with ultrasound based on ten key clinical questions: 1. Is stroke volume abnormal? 2. Is stroke volume responsive to fluid, vasopressors or inotropes? 3. Is the aorta abnormal? 4. Is the aortic valve, mitral valve or tricuspid valve severely abnormal? 5. Is there systolic anterior motion of the mitral valve? 6. Is there a regional wall motion abnormality? 7. Are there features of raised left atrial pressure? 8. Are there features of right ventricular impairment or raised pulmonary artery pressure? 9. Are there features of tamponade? 10. Is there venous congestion? FUSIC HD is the first system of its kind to interrogate major cardiac, arterial and venous structures to direct time-critical interventions in acutely unwell patients. This article explains the rationale for this accreditation, outlines the training pathway and summarises the ten clinical questions. Further details are included in an online supplementary appendix.

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The role of ultrasound scanning (USS) in right iliac fossa (RIF) pain: Is USS imaging delaying emergency appendicectomies? (2015)

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Type of publication:
Conference abstract

Author(s):
*Sukha A., *Luke D.

Citation:
International Journal of Surgery, November 2015, vol./is. 23/(S114)

Abstract:
Aim: This project investigates USS results from patients who had undergone appendicectomies to assess the sensitivity and specificity in detecting a histology positive acute appendicitis. We also investigated whether the decision to USS delayed an emergency procedure. Methods: Retrospective data collection between January-June 2014. Data was collected from Theatre log books, Pathology/PACS systems. Results: Between January-June 2014, 226 appendectomies were performed on the emergency-operating list. 15% (n = 34) ha d undergone pre-operative USS (74% Female, Mean age = 27 years). 76% (n = 26) of those who had a scan went onto have a diagnostic laparoscopy and appendicectomy, 24% (n = 8) had an open appendicectomy.53% (n = 18) were found to have a histology proven positive appendicitis. USS as an investigation to detect acute appendicitis demonstrated a sensitivity of 22.2% an d specificity of 68.8%, PPV of 44.4% and a NPV of 44.0%. A mean delay of 0.97 days was observed from admission to operation due to USS. Conclusion: US S result often does not change the definitive management in patients with ongoing RIF pain. Diagnostic laparoscopy can be therapeutic even in the absence of appendicitis. With USS delaying time to theatre and increasing hospital stay we conclude the USS has a limited role in investigating RIF pain in a patient presenting with the classic acute appendicitis.