Document Type

Theses, Masters

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This item is available under a Creative Commons License for non-commercial use only

Publication Details

Thesis presented To the School of Physics Dublin Institute of Technology For the Degree of Master of Philosophy, 2017.

Abstract

Transthoracic Echocardiography (TTE) is a technique for scanning the human heart using ultrasound. It enables us to acquire vital information about the size, structure and function of the heart. This test is a crucial cardiac diagnostic test. Historically TTE was used only in cardiology departments, undertaken by trained personnel called cardiac physiologists or cardiology doctors. More recently, TTE has been recognized to be very useful in the management of critically ill patients in the intensive care and high dependency units of our hospitals. Currently bedside TTE on these patients is performed by cardiac physiologists who are generally only available during the hours of 8am to 5pm Monday to Friday or by the cardiology registrar who may be only available on a limited basis. In 2012 a pilot training programme in TTE for intensivists was undertaken at the Mater Misericordiae University Hospital (MMUH) Critical Care Complex. The aim of the programme was to teach basic echocardiography skills to intensive care fellows over a six month period. This overall study expands on that pilot study and evaluates a training course for critical care fellows in practical and cognitive aspects of basic echocardiography. Purpose of study Achieving competency in TTE by intensive care fellows has become officially endorsed by ICU training bodies. During 2013 the Joint Faculty of Intensive Care Medicine Ireland, formally recognized TTE as an important and desirable skill for the ICU fellow in training. Since 2014 the Australian College of Intensive Care Medicine requires all ICU fellows in training to complete an approved basic TTE training course. Therefore,it is clear that the future of intensive care medicine programmes in Ireland must include formal echocardiography training. Methodology In January 2014 we introduced data collection sheets on our bi annual hands-on training course in the MMUH Intensive Care Department. At the end of the 20 week training programme the fellows were given a written exam, video cases and a practical exam and the results were collated in data sheets. The study was a comparison between expert and fellow – with expert being the gold standard/reference – in acquiring the echo views and assessing the specific clinical domains required for a critical care fellow.

Results The results showed that after 20 weeks (40 hours) of training the fellows showed competency in acquiring the standard echo views, and also showed a favourable comparison with expert in terms of assessing the clinical domains required for a critical care fellow. Conclusion It is recommended that basic echocardiography should be part of the curriculum for Irish critical care fellows. This study demonstrates that a suitably structured 20 week training programme in TTE for intensive care fellows can achieve competency in performing a TTE in the intensive care setting.

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