Nurse-performed focused ultrasound in the emergency department: A systematic review

The objective of this systematic review was to examine the characteristics and diagnostic accuracy of focused ultrasonography performed by emergency nurses.

Focused ultrasonography is a limited, real-time, goal-directed examination performed to answer specific clinical questions. Its use within the ED setting has increased rapidly over the past two decades. However, little is known about the accuracy of focused ultrasonography performed by emergency nurses.

Systematic review.

Four databases - ProQuest, Medline, SCOPUS, CINAHL - the Cochrane Library and the National Institute of Clinical Excellence were searched from date of inception to July 2018; with no language restrictions applied. Studies were identified using predetermined inclusion criteria. Data were extracted and summarised, and underwent evaluation using published valid criteria.

Sixteen studies met inclusion; three main applications of focused ultrasonography by emergency nurses were identified: procedural guidance, trauma, and soft tissue and musculoskeletal injuries. Overall study quality was high; 9 studies included a form of comparison group. Majority of studies examined nurse accuracy; three studies additionally investigated patient orientated outcomes that included pain, comfort and satisfaction.

Focused ultrasonography performed by emergency nurses was found to be highly accurate, consistent and safe. Standardisation of training and professional development of emergency nurses in use of focused ultrasonography has been identified. Further research is needed to examine diagnostic accuracy of nurse-performed ultrasonography across a wider range of acute conditions commonly managed by advanced nurse roles in the emergency department setting.