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Impact of the introduction of emergency ultrasound to one large UK emergency department: the REBUS study
  1. T'ng Choong Kwok1,
  2. Sue Johnson1,
  3. Matthew James Reed1,2
  1. 1College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
  2. 2EMeRGE, Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr M J Reed, Emergency Department, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK; mattreed1{at}hotmail.com

Abstract

Aim Firstly, to detail the experiences of one UK training region in establishing an emergency ultrasound (EU) training programme and secondly, to report the initial 30 months of EU scanning experience.

Methods Prospective study of all documented emergency department (ED) ultrasound scans. Results were extracted from written paper reports and/or electronically saved images. Details of scan date, time, type of scan, grade of operator, supervision status (whether supervised by a level 1 competent scanner) and whether the scan was clinical (performed or supervised by a level 1 operator) or training, were recorded. EU scans were reviewed for quality (internal quality assurance) and for diagnostic accuracy (external quality assurance).

Results Between 14 January 2009 and 4 July 2011, 626 scans were performed by 41 operators. 263 (42%) scans were completed outside of normal working hours (09:00 to 17:00). There were 251 abdominal aorta and inferior vena cava scans (40% of all scans) and 198 focused assessment with sonography in trauma scans (32%). The number of scans performed by each operator varied widely. 87 scans (14%) were supervised but the majority (459; 73%) were not. 484 (77%) scans were for training purposes, 124 (20%) were clinical scans and the majority (401; 63%) were performed by either speciality registrars (ST4-6) or specialist registrars (SpR). When the three commonest types of scans performed were analysed, eight false positives and 11 false negatives were identified. Only seven of these were deemed of poor quality and none led to poor patient outcome.

Conclusions Since the acquisition of our ED ultrasound machine and the development of a quality assured training programme, on average 20 scans per month have been performed in the ED, with no known adverse patient outcomes.

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Footnotes

  • Competing interests None.

  • Ethics approval This study was deemed to be a service evaluation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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