Survey of the training and use of echocardiography and lung ultrasound in Australasian intensive care units

expertise (diagnostic versus focused) was highest in TTE (32 %) compared with TOE (22 %) and LU (12 %). The proportions of intensivists untrained in TTE and LU was 41 % and 30 %, respectively. Perceived barriers included lack of organized training (38 %) and time for training (25 %). Other barriers included a perceived lack of need for training (18 %), insufficient equipment (14 %), and resistance from other ultrasound providers (4 %). The most commonly reported training programs were tertiary courses, such as provided by the Australasian Society of Ultrasound in Medicine (68 %) and University of Melbourne (59 %), rather than board examinations or hands-on workshops. We conclude that although TTE and LU are used frequently in Australasian teaching ICUs, many ICU physicians are yet to be trained due to lack of ICU training programs and time for training. Although tertiary courses are popular and provide training to diagnostic level, they are lengthy and depend on trainers and patient caseload and are not, therefore, scalable. An attractive alternative is to begin training in medical school and to train more physicians in basic ultrasound with shorter, more efficient, and hands-on courses utilizing the internet and ultrasound simulators [1], advancing to a diagnostic level only if required.


INFORMATION AND CONSENT
You are invited to take part in this quality assurance project. Participation is voluntary and you may decline if you wish. If you decide to take part and later change your mind, you are free to withdraw from the project at any stage.
Please read this information and ask questions if you need more information. Once you understand what the project is about and if you agree to take part in it, please proceed to complete the short questionnaire provided.

Purpose
This survey seeks to audit the practices and training in bedside point-of-care echocardiography and lung ultrasound performed by consultant intensvists to facilitate the management of critically ill patients.
You are invited to participate in this research project because you are a the Head or acting Head of Department at an accredited Australasian ICU.

Procedures
Participation in this project will involve the completion of a short questionnaire which should only take 1-10 minutesof your time.

Possible Risks (if applicable)
Participation in this project will involve no risks and minimal inconvenience 5. Privacy, Confidentiality and Disclosure of Information Any information obtained in connection with this project and that can identify you will remain confidential. It will only be disclosed with your permission, except as required by law. In any publication of the results of the project, information will be provided in such a way that you cannot be identified.

Results of Project
Upon completion of the study we intend to present the results of the survey in the form of a presentation or scientific paper for submission to a peer-reviewed journal. Results of the survey will be made available to participants upon request.

Diagnostic or comprehensive echocardiography
Diagnostic echocardiography (TTE or TOE) is a complete systematic examination that is performed according to the guidelines published by the American Society of Echocardiography.(1, 2)

Focused cardiac ultrasound (FCU)
FCU is a focused examination of the cardiovascular system performed by a physician by using ultrasound as an adjunct to the physical examination to recognize specific ultrasonic signs that represent a narrow list of potential diagnoses in specific clinical settings. Focused cardiac ultrasound is an abbreviated, goal-directed form of transthoracic echocardiography (3) or transoesophageal echocardiography (4) such uses included assessment and monitoring of left ventricular volume and function.

Diagnostic lung ultrasound
Diagnostic lung ultrasound is a comprehensive examination of the pleural and parenchyma (5).

Focused lung ultrasound
Focused lung ultrasound is a focused examination of the respiratory system performed by a physician by using ultrasound as an adjunct to the physical examination to recognize specific ultrasonic signs that represent a narrow list of potential diagnoses in specific clinical settings such as pleural effusion and interstitial syndrome. Focused lung ultrasound is an abbreviated, goal-directed form of diagnostic lung ultrasound.
None: All TTE is performed by another service such as cardiology or radiology. i.e. ICU staff do not perform any TTE.
Focused TTE: Some TTE is performed by ICU consultant staff but is restricted to focused TTE, such as for assessment of ventricular volume and function. Diagnostic TTE is referred to another service such as cardiology or radiology.

Diagnostic TTE: Some diagnostic TTE is performed by ICU consultant staff.
None: All TOE is performed by another service such as cardiology, radiology or anaesthesia. i.e. ICU staff do not perform any TOE.

Miniature TOE monitoring (eg. hTEE Imacor) is performed in your ICU.
Focused TOE: Some TOE is performed by ICU consultant staff but is restricted to focused TOE, such as for assessment of ventricular volume and function. Diagnostic TOE is referred to another service such as cardiology or radiology (eg. valvular quantification or aortic dissection).
Diagnostic TOE: Some diagnostic TOE is performed by ICU consultant staff.

How many consultant ICU staff (fractional or full-time) are employed in your ICU?
Q3.

What proportion (%) of your consultant ICU staff perform focused or diagnostic TTE?
Q4.

Focused cardiac ultrasound (FCU)
FCU is a focused examination of the cardiovascular system performed by a physician by using ultrasound as an adjunct to the physical examination to recognize specific ultrasonic signs that represent a narrow list of potential diagnoses in specific clinical settings. Focused cardiac ultrasound is an abbreviated, goal-directed form of transthoracic echocardiography (3) or transoesophageal echocardiography (4) such uses included assessment and monitoring of left ventricular volume and function.

What proportion (%) of your consultant ICU staff perform focused or diagnostic TOE?
Qualtrics Survey Software https://co1.qualtrics.com/ControlPanel/Ajax.php?action=GetSurv... Focused lung ultrasound: Some lung ultrasound is performed by ICU consultant staff but is restricted to focused lung ultrasound, such as for assessment of pleural effusions and interstitial syndrome. Diagnostic lung ultrasound is referred to another service such respiratory medicine or radiology.
Diagnostic lung ultrasound: Some diagnostic lung ultrasound is performed by ICU consultant staff.

No current organised (and regular) echocardiography training program for ICU staff
Out-sourced: Echocardiography training program is provided for ICU staff from another service, eg. cardiology

In-house: Echocardiography training program is provided by ICU staff
No current organised (and regular) lung ultrasound training program for ICU staff Out-sourced: lung ultrasound training program is provided for ICU staff from another service, eg. respiratory In-house: Lung ultrasound training program is provided by ICU staff

Q6.
Regarding performance of lung ultrasound in your ICU:

Diagnostic lung ultrasound
Diagnostic lung ultrasound is a comprehensive examination of the pleural and parenchyma (5).

Focused lung ultrasound
Focused lung ultrasound is a focused examination of the respiratory system performed by a physician by using ultrasound as an adjunct to the physical examination to recognize specific ultrasonic signs that represent a narrow list of potential diagnoses in specific clinical settings such as pleural effusion and interstitial syndrome. Focused lung ultrasound is an abbreviated, goal-directed form of diagnostic lung ultrasound.

Q7.
What proportion (%) of your consultant ICU staff perform focused or diagnostic lung ultrasound?
Q8. Training of echocardiography for ICU staff: Q9. Training of lung ultrasound for ICU staff: