Role extension in advanced ultrasound practice: A framework approach and case study

Abstract

Introduction: Role extension into novel areas of ultrasound practice can be challenging for health care professionals. Expansion into existing areas of advanced practice typically occurs using established processes and accredited training; however, in areas where there is no formal training, there can be a lack of support for how to develop new and progressive clinical roles. Topic Description: This article presents how the use of a framework approach for establishing areas of advanced practice can support individuals and departments with safely and successfully developing new roles in ultrasound. The authors illustrate this via the example of a gastrointestinal ultrasound role, developed in an NHS department. Discussion: The framework approach comprises three elements, each interdependent upon and inform each other: (A) Scope of practice, (B) Education and competency and (C) Governance. (A) Defines (and communicates) the role extension and area(s) of subsequent ultrasound imaging, interpretation and reporting. By identifying the why, how and what is required this informs (B) the education and assessment of competency for those taking on new roles or areas of expertise. (C) Is informed by (A) and is an ongoing process of quality assurance to safeguard high standards in clinical care. In supporting role extension, this approach can facilitate new workforce configurations, skill expansion and enable increasing service demands to be met. Summary: By defining and aligning the components of scope of practice, education/competency and governance, role development in ultrasound can be initiated and sustained. Role extension utilising this approach brings benefits for patients, clinicians and departments.

A proposed framework for point of care musculoskeletal ultrasound and ultrasound image-guided interventions by physiotherapists: scope of practice, education and governance

“…The PoCUS framework approach was devised by the lead author (stemming from longstanding work across a range of sonography and PoCUS specialities in the domains of education, work-force planning, policy and legislation) in response to a perceived need to provide comprehensive solutions for PoCUS integration into healthcare systems. It has been recently used to support PoCUS expansion and consolidation for non-physiotherapy professions (Speech and Language Therapy [ 18 ] and Sonography scope expansion [ 19 ]) and physiotherapy specialisms such as lung/critical care [ 7 ] and pelvic health [ 8 ]. Correspondingly, this paper shares some generic content with the above framework publications.…”

Ultrasound image guided injection of botulinum toxin for the management of spasticity: A Delphi study to develop recommendations for a scope of practice, competency, and governance framework

“… 11 , 12 , 13 , 14 , 15 The use of UI to improve localization is an area of rapid clinical expansion due to the ability to directly visualize: (1) contractile tissue, including delineating different muscles within an anatomic compartment; and (2) injection risk areas, such as the neurovascular bundle and theoretically reduce the risk of an adverse event. 7 , 16 Technological innovations also mean that access to portable, low-cost ultrasound imaging systems has further reduced barriers to using ultrasound. 7 , 10 , 16 , 17 …”

“…7 , 16 Technological innovations also mean that access to portable, low-cost ultrasound imaging systems has further reduced barriers to using ultrasound. 7 , 10 , 16 , 17 …”

“…A framework approach has been previously used 16 , 18 , 19 , 20 to define and align the elements of scope of practice (Scope), education for competency and governance for clinicians performing point of care ultrasound (PoCUS) imaging – as a mechanism for consolidating and expanding access to PoCUS. The framework approach ( fig 1 ; explanation of terms in table 1 ) is premised upon the inter-relationship of each of the components, whereby explicit alignment of each of the components provides the foundation for consolidation and expansion of practice.…”

“…This paper therefore shares some generic content with other areas of practice for PoCUS and we aim to provide a consistent approach to implementation and practice development support. 16 , 18 , 19 , 20

Fig 1 PoCUS framework triangle; adapted for UI in spasticity management (20). A framework for PoCUS.

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