Written by: Hannah Conway, National FUSICĀ® Heart Lead | Blog Editor @ g&h BLOG
Date: 19th August 2024
Credit to authors šš» Aziz, S., Edmunds, C.T. & Barratt Article Link: https://sjtrem.biomedcentral.com/articles/10.1186/s13049-024-01224-y TL;DR:Ā A UK Helicopter Emergency Medical Service (HEMS) team successfully implemented a point-of-care ultrasound (PoCUS) archiving system and governance framework, significantly improving ultrasound usage in emergency care. This innovative approach serves as a model for enhancing pre-hospital diagnostic tools across emergency medical services.
Introduction
In a groundbreaking development for emergency medical services, East Anglian Air Ambulance (EAAA), a UK HEMS provider, has revolutionised pre-hospital care by implementing a new PoCUS archiving system and governance framework. This article explores the implementation process, key features, and potential impact of this innovative system on emergency care.
Context and Background
The use of PoCUS in pre-hospital settings has been rapidly expanding, offering critical diagnostic capabilities in time-sensitive emergencies. However, less than a third of UK emergency medical services (EMS) utilise imaging archiving for PoCUS, and even fewer review saved images as part of a clinical governance structure. This gap in practice led EAAA to develop a comprehensive solution to enhance PoCUS utilisation and governance.
Implementation Process
The journey to enhance pre-hospital ultrasound capabilities involved several crucial steps:
š Hardware and Software Selection: After careful consideration, EAAA chose the Butterfly iQā¢ device, which offers advantages such as a single, portable, battery-operated probe and secure cloud-based storage.
š System Integration: The team integrated the new PoCUS system with existing HEMS workflows and technologies, ensuring seamless operation in the field.
š Data Security: The implemented system complies with General Data Protection Regulation (EU 2016/679) and UK Data Protection Act (2018) legislation, ensuring patient data protection.
š Multidisciplinary Collaboration: A team of emergency physicians, paramedics, and IT specialists worked together to develop comprehensive guidelines, training programmes, and quality assurance procedures.
Key Features of the New System
Image Archiving: The system allows for efficient storage and retrieval of ultrasound images, enhancing continuity of care and enabling retrospective analysis.
Quality Assurance: All recorded POCUS examinations are reviewed by an EAAA PoCUS supervisor within 24 hours of finalisation, ensuring high-quality and accurate interpretations.
Education and Competency: A robust educational program was developed, including a new sign-off process, a one-day PoCUS training course, and ongoing mentorship.
Standardised Documentation: Predefined worksheets for each PoCUS examination were introduced to standardise documentation of findings.
Impact on Emergency Care
The implementation of this new PoCUS system has led to several significant improvements:
š Enhanced Clinical Decision-Making: Access to high-quality ultrasound images allows for more accurate diagnoses and treatment decisions in the field.
šParamedic Involvement: The study found that 25.4% of PoCUS examinations were conducted by paramedics, with image quality comparable to physicians.
šHigh Compliance: 96.7% of patient examinations underwent quality assurance, demonstrating strong organisational commitment to the new system.
šStrong Inter-rater Reliability: There was strong agreement between reviewers and HEMS clinicians across all examination types, increasing confidence in the PoCUS findings.
Key Findings
š Cardiac ultrasound was the most common PoCUS examination (60%), aligning with the high prevalence of out-of-hospital cardiac arrests attended by EAAA.
š Image quality was not significantly different between physicians and paramedics for each examination type.
š The most common areas for improvement identified during quality assurance were adjustments to image gain and depth.
Future Implications
The success of this PoCUS archiving and governance system in the UK HEMS setting opens up exciting possibilities for the broader emergency medical services field:
Scalability: The model could be adapted and implemented by other HEMS and ground-based emergency medical services.
AI Integration: Future developments could incorporate artificial intelligence for image analysis, potentially further improving diagnostic accuracy and speed.
Continuous Improvement: The system allows for ongoing refinement of PoCUS techniques and training based on collected data and feedback.
Conclusion
The implementation of this PoCUS archiving system and governance framework by EAAA represents a significant leap forward in pre-hospital emergency care. By enhancing diagnostic capabilities, improving clinical decision-making, and providing valuable data for ongoing training and research, this innovation has the potential to transform emergency medical services. As other services look to adopt similar systems, we can anticipate continued advancements in pre-hospital care, ultimately leading to better outcomes for patients in critical situations.
Key Takeaway: Effective PoCUS archiving and governance significantly enhance emergency care quality, clinical decision-making, and patient outcomes in HEMS. The model serves as a roadmap for other emergency services, with potential future integration of AI promising further advancements in ultrasound diagnostics and training.
Do you use a dedicated archiving system for your PoCUS studies?
Yes
No
No, but I would like to set one up!
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