Advanced Practice Provider Point-of-Care Ultrasound Guidelines

Originally approved June 2019

Given both the substantial contribution of Advanced Practice Providers (APPs) in the provision of emergency care, and the 2016 Model of the Clinical Practice of Emergency Medicine recognizing emergency ultrasound (EUS)* as a skill integral to emergency medicine, it is important to consider the value of APP-performed EUS, and how EUS can be safely, efficiently, and effectively employed by all clinicians providing care in the emergency setting.^1-4

APPs seeking to integrate EUS into their practice should follow the same education and competency standards outlined in ACEP’s Ultrasound Guidelines: Emergency, Point-of-care, and Clinical Ultrasound Guidelines in Medicine.⁵ APPs who have demonstrated adherence to these guidelines may be considered eligible for credentialing in EUS according to institutional and regional practices. EUS program leadership is encouraged to incorporate APPs into EUS training programs when feasible and support the credentialing of APPs in EUS when competency standards have been met. Departmental leadership may consider both static and dynamic factors such as resource allocation, local culture, provider training and levels of experience with EUS to make decisions as to the final APP EUS program architecture.^6,7

In accordance with ACEP’s Guidelines Regarding the Role of Physician Assistants and Advanced Practice Registered Nurses in the Emergency Department, EUS directors are encouraged to develop local training and practice standards for APP ultrasound, defining the institutional scope of practice for APP EUS.⁶ In addition, physician oversight includes supervisory agreements and roles as defined by the above Guidelines.

For APPs practicing in rural and austere environments, EUS training still needs to adhere to the recommendations in ACEP’s Guidelines. However, the use of online modalities, tele-ultrasound, and cloud-based applications which offer the opportunity for remote image review and quality assurance, can be used for physician oversight in this setting. There is an expectation of physician supervision of EUS, and emergency physicians providing oversight in this setting should be trained and credentialed in EUS. Given the significant benefits of EUS for patient care, APPs trained in EUS should not be discouraged from integrating those skills into their practice.

Appropriately trained APPs who demonstrate proficiency in administrative tasks associated with EUS program operations should be considered capable to assume administrative positions within EUS programs as deemed appropriate by EUS physician directors. Examples include, but are not limited to, experiences as sonographers prior to becoming APPs, APP completion of EUS fellowships and completion of EUS management courses.

Within these parameters, the American College of Emergency Physicians supports the training, practice and integration of APP EUS into current EUS programs.

* EUS is synonymous with emergency medicine point-of-care ultrasound (EM POCUS) in this document

1. Hall MK, Burns K, Carius M, et al. State of the National Emergency Department Workforce: Who Provides Care Where? Ann Emerg Med. 2018;72(3):302-7. doi:10.1016/j.annemergmed.2018.03.032
2. Phillips AW, Klauer KM, Kessler CS. Emergency physician evaluation of PA and NP practice patterns. JAAPA. 2018;31(5):38-43.
3. Menchine MD, Wiechmann W, Rudkin S. Trends in midlevel provider utilization in the emergency departments from 1997 to 2006. Acad Emerg Med. 2009;16:963–969.
4. American College of Emergency Physicians. 2016 Model of the Clinical Practice of Emergency Medicine. [policy statement]. Approved September 2016.
5. American College of Emergency Physicians. Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine. [policy statement]. Approved June 2016. Accessed April 30, 2019.
6. American College of Emergency Physicians. Guidelines Regarding the Role of Physician Assistants and Advanced Practice Registered Nurses in the Emergency Department. [policy statement]. Approved June 2013. Accessed April 30, 2019.
7. Chin, E. and Summers, S. (2018). Point of Care Ultrasound Issues for Advanced Practice Providers and Nursing Programs. In: V. Tayal, M. Blaivas and T. Foster, ed., Ultrasound Program Management, 1st ed. Springer International Publishing, pp.115-125.