Emergency Point-of-Care Ultrasound Stewardship – A Joint Position Paper by EuSEM and EFSUMB and Endorsed by IFEM and WFUMB

 

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Abstract

Emergency Medicine Point-of-Care Ultrasound (EMPoCUS) is a convincing concept. It has spread rapidly because of its intuitive, simple applicability and low equipment costs. The speed of its emerging growth frequently outpaces the development of quality assurance and education. Indeed, education standards vary worldwide, and in some cases seem to neglect the principles of modern competence-based education. Additional challenges are encountered such as remote or low resource medical practice. Here, EMPoCUS might be the only ad-hoc imaging modality available. Once mastery of EMPoCUS is achieved, emergency physicians should be able to independently and efficiently care for their patients using a variety of PoCUS skills. However, most curricula only define these tasks as non-binding and in general terms or use outdated measures, such as length of training and self-reporting of achieved examinations with variable oversight, or administrative measures to create educational milestones. This threatens to take quality assurance down the wrong path. It created a scenario in which concrete EMPoCUS skill outcome measures that would realistically reflect the training objectives and simultaneously would be easily observable and verifiable are lacking. In view of the dangers of poorly controlled EMPoCUS dissemination and the current lack of European guidelines, we would like to set central standards for European EMPoCUS stewardship based on a critical review of the current situation. This position paper, which was jointly developed by EuSEM and EFSUMB and endorsed by IFEM and WFUMB, is also intended to accompany the EFSUMB/EuSEM guidelines on PoCUS currently being prepared for publication.

Zusammenfassung

Der notfallmedizinische Point-of-Care-Ultraschall (EMPoCUS) ist ein überzeugendes Konzept. Es hat sich aufgrund seiner intuitiven, einfachen Anwendbarkeit und der geringen Gerätekosten rasch verbreitet. Die Geschwindigkeit des sich abzeichnenden Wachstums übertrifft häufig die Entwicklung der Qualitätssicherung oder der Ausbildung. In der Tat variieren die Ausbildungsstandards weltweit und scheinen in einigen Fällen die Grundsätze einer modernen kompetenzbasierten Ausbildung zu vernachlässigen. Hinzu kommen weitere Herausforderungen wie abgelegene oder ressourcenarme medizinische Institutionen. Hier könnte EMPoCUS die einzige ad-hoc verfügbare Bildgebungsmodalität sein. Wenn die Notfallärzte die EMPoCUS-Ausbildung abgeschlossen haben, sollten sie in der Lage sein, ihre Patienten unter Einsatz einer Vielzahl von PoCUS-Spielarten unabhängig und effizient zu versorgen. In den meisten Curricula werden diese Anforderungen jedoch nur unverbindlich und allgemein definiert oder es werden veraltete Maßstäbe verwendet – wie die Dauer der Ausbildung, die Selbsteinschätzung der durchgeführten Untersuchungen mit variabler Kontrolle oder administrative Maßstäbe zur Erstellung von Ausbildungsmeilensteinen. Damit droht die Qualitätssicherung in die falsche Richtung zu laufen. Es wurden Verhältnisse geschaffen, in denen es an konkreten Ergebniskriterien für EMPoCUS-Skills mangelt, welche die Ausbildungsziele realistisch widerspiegeln und gleichzeitig leicht beobachtbar und überprüfbar wären. Angesichts der Gefahren einer unzureichend kontrollierten EMPoCUS-Verbreitung und von fehlenden europäischen Richtlinien möchten wir auf der Grundlage einer kritischen Bestandsaufnahme zentrale Standards für eine europäische EMPoCUS-Stewardship setzen. Dieses Positionspapier, das gemeinsam von EuSEM und EFSUMB entwickelt und von IFEM und WFUMB unterstützt wurde, soll auch die EFSUMB/EuSEM-Leitlinien zu PoCUS begleiten, die derzeit zur Veröffentlichung vorbereitet werden.

Publication History

Received: 08 November 2022

Accepted after revision: 20 February 2023

Article published online:
30 March 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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