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Acta Anaesthesiol Scand. 2018 Oct 17. doi: 10.1111/aas.13276. [Epub ahead of print]

Remote real-time supervision via tele-ultrasound in focused cardiac ultrasound: A single-blinded cluster randomized controlled trial.

Author information

1
Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.
2
Emergency Department Regional, Hospital West Jutland, Herning, Denmark.
3
Department of Internal Medicine, Regional Hospital Randers, Randers, Denmark.
4
Department of Anesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark.
5
Department of Anesthesiology, Regional Hospital West Jutland, Herning, Denmark.

Abstract

BACKGROUND:

Supervision via tele-ultrasound presents a remedy for lacking on-site supervision in focused cardiac ultrasound, but knowledge of its impact is largely absent. We aimed to investigate tele-supervised physicians' cine-loop quality compared to that of non-supervised physicians and compared to that of experts.

METHODS:

We conducted a single-blinded cluster randomized controlled trial in an emergency department in western Denmark. Physicians with basic ultrasound competence scanned admitted patients twice. The first scan was non-supervised, and the second was non-supervised (control) or tele-supervised (intervention). Finally, experts in focused cardiac ultrasound scanned the same patient. Two blinded observers graded cine-loops recorded from all scans on a 1-5 scale. The outcome was the mean summarized scan gradings compared with a linear mixed-effects model.

RESULTS:

In each group, 10 physicians scanned 44 patients. From the mean summarized gradings, on a scale from 4 to 20, the second non-supervised scan grading was 10.9 (95% CI 10.2-11.7), whereas the tele-supervised grading was 12.6 (95% CI: 11.8-13.3). From the first to the second scan, tele-supervised physicians moved 9% (1.09; 95% CI: 1.00-1.19; P = 0.041) closer to the experts' quality than the non-supervised physicians.

CONCLUSION:

Tele-supervised physicians performed scans of better quality than non-supervised physicians. The present study supports the use of tele-supervision for physicians with basic focused ultrasound competence in a setting where on-site supervision is unavailable.

PMID:
30328094
DOI:
10.1111/aas.13276

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