BackgroundSupervision via tele‐ultrasound presents a remedy for lacking on‐site supervision in focused cardiac ultrasound, but knowledge of its impact is largely absent. We aimed to investigate tele‐supervised physicians’ cine‐loop quality compared to that of non‐supervised physicians and compared to that of experts.MethodsWe conducted a single‐blinded cluster randomized controlled trial in an emergency department in western Denmark. Physicians with basic ultrasound competence scanned admitted patients twice. The first scan was non‐supervised, and the second was non‐supervised (control) or tele‐supervised (intervention). Finally, experts in focused cardiac ultrasound scanned the same patient. Two blinded observers graded cine‐loops recorded from all scans on a 1–5 scale. The outcome was the mean summarized scan gradings compared with a linear mixed‐effects model.ResultsIn each group, 10 physicians scanned 44 patients. From the mean summarized gradings, on a scale from 4 to 20, the second non‐supervised scan grading was 10.9 (95% CI 10.2‐11.7), whereas the tele‐supervised grading was 12.6 (95% CI: 11.8‐13.3). From the first to the second scan, tele‐supervised physicians moved 9% (1.09; 95% CI: 1.00‐1.19; P = 0.041) closer to the experts’ quality than the non‐supervised physicians.ConclusionTele‐supervised physicians performed scans of better quality than non‐supervised physicians. The present study supports the use of tele‐supervision for physicians with basic focused ultrasound competence in a setting where on‐site supervision is unavailable.

Minor emergency departments (ED) struggle to access sufficient expertise to supervise learners of lung and cardiac point-of-care ultrasound (POCUS). Using tele-ultrasound (tele-US) for remote supervision may remedy this situation. We aimed to evaluate the feasibility of real-time supervision via tele-US when applied to an everyday ED clinic. We conducted a mixed methods study that assessed practical feasibility, determined performance, and explored users' acceptability of supervision via tele-US. Technical performance was assessed quantitatively by the ratio in mean gray value between images on site and as received by the supervisor, and by after-compression frame rate. Qualitatively, 12 exploratory semi-structured interviews were conducted with exposed junior doctors and supervisors. Remote supervision via tele-US was performed with 10 junior doctors scanning 45 included patients. During performance assessment, neither alternating internet connection nor software significantly changed the mean gray value ratio. The lowest median frame rate of 4.6 (interquartile range [IQR]: 3.1-5.0) was found by using a 4G internet connection; the highest of 28.5 (IQR: 28.5-29.0) was found with alternative computer and local area network internet connection. In interviews, supervisors stressed the importance of preserving frame rate, and junior doctors emphasized a need for shared ultrasound terminology. In the qualitative analysis, setup mobility, accessibility, and time consumption were emphasized as being of key importance for future clinical implementations. Remote supervision via a commercially available and low-cost tele-US setup is operational for both junior doctors and supervisors when applied to lung and cardiac POCUS scans of hospitalized patients.

Background: Minor emergency departments (ED) struggle to access sufficient expertise to supervise learners of lung and cardiac point-of-care ultrasound (POCUS). Using tele-ultrasound (tele-US) for remote supervision may remedy this situation. We aimed to evaluate the feasibility of real-time supervision via tele-US when applied to an everyday ED clinic. Methods: We conducted a mixed-methods study that assessed practical feasibility, determined performance, and explored users’ acceptability of supervision via tele-US. A tele-US setup was established and temporarily implemented in the emergency department of the Regional Hospital West Jutland in the Central Denmark Region. We intended to expose 10 junior doctors to five tele-supervised lung and cardiac POCUS examinations. Qualitatively, exposed doctors’ and supervisors’ acceptability were unfolded by exploratory semi-structured interviews addressing their impression, satisfaction and perceived benefits. Technical performance was assessed quantitatively by the ratio in mean grey value (MGV) between images on site and as received by the supervisor, and by after-compression frame rate; MGV and frame rate were measured on five different days with alternating on-site laptops, software and internet connection. Results: Remote supervision via tele-US was performed with 10 junior doctors scanning 45 included patients. Qualitatively, 12 exploratory semi-structured interviews were conducted with exposed junior doctors and supervisors. Supervisors stressed the importance of preserving frame rate, and junior doctors emphasized a need for shared ultrasound terminology. Overall, setup mobility, accessibility, and time consumption were emphasized as being of key importance for future clinical implementations. During performance assessment, neither alternating internet connection nor software significantly changed the mean grey value ratio. The lowest median frame rate of 4.6 (interquartile range [IQR]: 3.1–5.0) was found by using a 4G internet connection; the highest of 28.5 (IQR: 28.5–29.0) was found with alternative computer and local area network internet connection.  Conclusions: Remote supervision via a commercially available and low-cost tele-US setup is operational for both junior doctors and supervisors when applied to lung and cardiac POCUS scans of hospitalized patients.