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Focused Intensive Care Echocardiography (FICE): A retrospective study in quality assurance to guide future practice on ICU

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Focused Intensive Care Echocardiography (FICE) allows clinicians to perform transthoracic sonography on ICU patients to monitor and guide clinical management. However, as clinicians can attain FICE accreditation with 50 scans (10 directly supervised and 40 requiring review), high quality scans and documentation must be achieved to ensure good patient care. 

126 scans over a 3-month period were examined for quality of documentation across several parameters. TTE reports were analysed using FICE accreditation protocol for guidance. These included checking whether patient details were saved, if a 3 lead ECG was attached and whether images obtained were saved from the FICE machine onto PACS (hospital images database). Reports were checked for if the user assessed ventricular function, evidence of pleural and pericardial collections and evidence of hypovolaemia. The number of views achieved out of the possible 4 was noted and if fewer, we looked to see if reasons were given.

2 scans were excluded due to corrupt image files, leaving 124. Fewer than 4 views were obtained in 86/124 (69.3%) studies (Fig.1.1). In 75/86 (87.2%) of these, no reason was given (Fig.1.2). The most common view to be missed was subcostal (62.0%). Images were saved to PACS in 89/124 (71.8%) cases (Fig.2.1) and out of these, ECGs were connected in 35/89 (39.3%) (Fig.2.2).  Chamber function, hypovolaemia and pericardial collections were not assessed on average 3.5% of the time (Fig.3.1). Pleural collection wasn’t assessed in 38/124 (30.6%) (Fig.3.2). 

FICE is a new practice and it could be anticipated that it may take time for users to accustom themselves to documentation procedure. ICU conditions mean that obtaining all 4 views is often difficult. However, reasons for not obtaining views were, for the most part, not given. The 3 lead ECG, important for the acquisition of complete digital loops, was often not connected. Hospital imaging studies should be always recorded and saved and the same should be expected of TTEs in ICU, which was not the case. These results indicate that there is significant progress to be made to ensure quality of FICE. This is fundamentally important to maintain quality of patient care. 

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