SJRH PoCUS Quality Assurance

The SJRH EM Ultrasound Program has set in place quality assurance guidance to ensure quality, facilitate education, and satisfy credentialing pathways. Supporting documentation can be accessed via the file store below.

 

Definitions

EMUS – Emergency Medicine Ultrasound – The use of ultrasound at the point of care/bedside in the Emergency Department to assist in diagnosis, treatment decisions and procedural guidance. (Also known as Point of care Ultrasound (PoCUS ) or Bedside Ultrasound). There is a large amount of evidence (see below) supporting the use of EMUS for the benefit of our patients.

EMUS Trainee – A clinician who has commenced the EMUS training with the expectation of acquiring the minimum competencies to practice independently

EMUS Provider – A clinician who has completed core EMUS training and demonstrated provider level competencies for the core EMUS applications

EMUS Instructor – A clinician who has completed core EMUS training and demonstrated instructor level competencies for the core EMUS applications

EMUS CQM Guidance

  1. The EMUS Program Director is responsible for EMUS CQM.
  2. Appropriate admin support and IT systems is required by the EDUS Program in order to deliver EMUS CQM.
  3. All Emergency Physicians/Residents should be either an EMUS trainee, provider or instructor.
  4. An EMUS Education Program must be in place for EDUS trainees.
  5. Core competencies require revalidation every 3 years. This may be demonstrated by regular EMUS instruction.
  6. All EMUS scans must be documented in the patient record in the form of a report that includes the following:
    1. Header: PoCUS / EDE
    2. Type of scan e,g AA Scan, Trauma, Early Pregnancy
    3. Findings
    4. Outcome e.g further diagnostic imaging requested, result communicated to surgeon etc
    5. It is recommended that All EMUS scans be associated with 1 or more (depending on application) saved image or clip as follows (see video of Sonosite SJRHEM – logging a scan web )
      1. Last Name of Patient
      2. PPRN
      3. Initials of clinician (in the ‘user’ field)
      4. Save Image/Clip  (see video of Sonosite SJRHEM – saving a clip or image web ) demonstrating positive findings or…
      5. Best Image/Clip for each recognised view demonstrating negative findings or..
      6. Close New Patient event (this keeps a record that the machine was used on this patient by the “user’ even if no images are saved)
      7. Full compliance with point 7 will result in a comprehensive file of all EMUS scans performed in the department.
      8. EMUS Trainees/Providers/Instructors who do not save scans should keep a personal log of all scans performed.

10. EMUS Trainees/Providers/Instructors should perform regular follow up audit on a sample of these. This data will be used in the revalidation process.

11. All scans performed by an EMUS trainee must be over-read by an EMUS provider. If an EMUS provider is not immediately available the report should be documented as a ‘training scan’, which should be considered non-contributory to patient management.

12. A sample of charts will be reviewed (by the program director or nominee) to ensure that EMUS Providers/Instructors are documenting EMUS scans correctly and that appropriate images have been saved. Follow up audit will be performed, if possible, to determine the final diagnosis / accuracy of EMUS scan. Confidential feedback will be provided to the EMUS provider/instructor and anonymous summaries to the department. This data may also be used to facilitate EMUS research projects.

13. All recorded EMUS scans will be archived and be available for later review if required.

14. This guidance has been agreed by the SJRH Department of Emergency Medicine as recommended practice for quality PoCUS.

15. Significant deviation from this guidance may result in a recommendation for additional training.

Further Reading:

ACEP Ultrasound CQM

CEM Ultrasound CQM

CAEP Position statement 

Ultrasound Files