LETTER TO THE EDITOR

Credentialing emergency clinicianperformed ultrasound in Australasiaemm_1358 571..572

Dear Editor,Congratulations to Dr Nagaraj and colleagues

on their interesting survey of ED ultrasound availabilityand credentialing. They were able to demonstratethe wide availability of ED ultrasound in accreditedAustralian EDs despite many departments nothaving a formal credentialing process in place. Theirsurvey demonstrated that only 39% of EDs hadminimum credentialing requirements as per the ACEMguidelines.1

There were no data presented regarding the compli-ance of individual practitioners with the credentialingprocess in their respective departments. It is reasonableto suspect that many emergency physicians would notbe compliant with their own credentialing process, butstill perform ultrasound. This was shown to be the casein similar studies performed in New Zealand and in theUSA.2 Therefore, properly credentialed practitioners inAustralia are certainly in the minority.

The accompanying editorial by Dr Goudie suggeststhat the ACEM credentialing process of ED clinical per-formed ultrasound would enhance patient care andsafety.3 How can it be that the majority of EDs in Aus-tralia seem content to perform ultrasound examinationswithout following ACEM guidelines for credentialing?Are the individual practitioners providing unsafe care?Or perhaps there are other views at hand.

One might argue that ultrasound is a ‘new’ compe-tency in Australian EDs and therefore mandates a cre-dentialing process for safe practice. But this is notcongruent with what is normally done. In the field ofEmergency Medicine, there is a vast and constantlyevolving knowledge base which continuously incorpo-rates new treatments, procedures, and technology. Thisis certainly not unique to ultrasound. It is an obligationof the individual practitioner to develop new skills,maintain competency and ensure continuous medicaleducation.

The ACEM policy for ultrasound credentialing ini-tially adopted in 2000 is specifically for trauma exami-nations and suspected AAA.4 As demonstrated in thesurvey by Nagaraj, emergency ultrasound has evolved

substantially over the last decade to include numerousother routine applications not covered under this cre-dentialing process.

The specialty of Emergency Medicine does notmandate individual credentialing for many proceduresthat are arguably as complex as point-of-care ultra-sound. For instance, there are no such credentialingrequirements for rapid sequence induction intubation,cardioversion, thrombolysis, chest-tube thoracostomyor even using a slit lamp. These competencies and pro-cedures are regulated under individual hospital privi-leges and scope of clinical practice.

Practising within our limitations is a constant consid-eration in the ED. Ultrasound is no different. Because ofthe vast field of Emergency Medicine, it is impossible tobe an expert in everything. One knows to never act onfindings unless there is reasonable clinical certainty. Forexample, if one is not sure about the findings on aslit-lamp examination, the assistance of an ophthalmolo-gist is sought, but this does not mean emergency phy-sicians cannot use a slit lamp.

There is no reason why ED performed ultrasoundshould be any different and require a separate creden-tialing process. There is no evidence that this is anunsafe practice, but denying emergency practitionersthe opportunity to use ultrasound whereas they jumpthrough the hoops of accreditation might well be. Itappears that the majority of practitioners of ED ultra-sound in Australia seem to agree.

The ACEM Ultrasound Subcommittee chaired by DrGoudie is to be congratulated for their success in pro-moting ultrasound in our specialty. It would accurate tostate that point-of-care ultrasound is now considered acore competency of Emergency Medicine in Australiaand is here to stay!

Competing interests

None declared.

References

1. Nagaraj G, Chu M, Dinh M. Emergency clinician performed ultra-sound: availability, uses and credentialing in Australian emer-gency departments. Emerg. Med. Australas. 2010; 22: 296–300.

doi: 10.1111/j.1742-6723.2010.01358.x Emergency Medicine Australasia (2010) 22, 571–572

© 2010 The AuthorEMA © 2010 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine

2. Kiuru S. Ultrasound in New Zealand emergency departments.ASUM Ultrasound Bull. 2006; 9: 21–4.

3. Goudie AM. Credentialing a new skill: What should the standardbe for emergency department ultrasound in Australasia? Emerg.Med. Australas. 2010; 22: 263–64.

4. ACEM. Policy on credentialing for ED ultrasonography:trauma examination and suspected AAA. July 2006. [Cited

August 2010.] Available from URL: http://www.acem.org.au/media/policies_and_guidelines/P22_Credentialling_for_ED_Ultrasonography.pdf

Brian Doyle

North West Regional Hospital, Burnie, Tasmania, Australia

Letter to the editor

572 © 2010 The AuthorEMA © 2010 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine