1. FASP Fetal Cardiac Ultrasound Education in UK
BMUS Summer School
24th June, 2017
University College Dublin
Dr Rita Phillips
Consultant Sonographer Advisor FASP UK
Senior lecturer UWE. Bristol
Advanced Practitioner Ultrasound RUH NHS Trust Bath

2. UK National Screening Committee (UKNSC)
Population screening programmes NHS abdominal aortic aneurysm (AAA) programme NHS bowel cancer screening (BCSP) programme NHS breast screening (BSP) programme NHS cervical screening (CSP) programme NHS diabetic eye screening (DES) programme NHS fetal anomaly screening programme (FASP) NHS infectious diseases in pregnancy screening (IDPS) programme NHS newborn and infant physical examination (NIPE) screening programme NHS newborn blood spot (NBS) screening programme NHS newborn hearing screening programme (NHSP) NHS sickle cell and thalassaemia (SCT) screening programme Screening and quality assurance (all programmes)
FASP UK Fetal cardiac training project

3. Fetal Anomaly Screening Programme
Combined Screening Test/NIPT
CRL between 45mms and 84mms
Quadruple test
between 14+2 weeks to 20 weeks
Fetal anomaly screening
18+0 to 20+6 (completed by 23 weeks)
FASP UK Fetal cardiac training project

4. FASP Policy Standards Education Information for Professional Women
Quality assurance
Service specification
Operational guidelines
FASP UK Fetal cardiac training project

5. The National FASP Team
Andrew Rostron – ANNB Programmes Lead Annette McHugh – Programme Manager Shirley Vickers – Project Lead Liane Powell –Project Lead Tessa Morgan– Data Manager Steve Kawandami – IT Specialist Lorraine Martin – Project Support Officer Advisors Mr Pranav Pandya – Clinical Advisor and chair of the steering group Dr Rita Phillips – Sonography Advisor Professor David Wright – DQASS Ian Smith & Carolyn Williams– Laboratory Advisors FASP Advisory Board with representation from stake holders from across the pathways
FASP UK Fetal cardiac training project

6. Sets out the ‘must-do’s’ for delivery of the screening programme
Set out how NHS Screening Programmes should be commissioned and delivered throughout England
Sets out the ‘must-do’s’ for delivery of the screening programme
FASP UK Fetal cardiac training project

7. FASP standards for 18+0 –20+6 weeks anomaly scan
The conditions screened for as a minimum in England
Conditions
Detection rate %)
Anencephaly 98
Open spina bifida 90
Cleft lip 75
Diaphragmatic hernia 60
Gastroschisis
Exomphalos 80
Serious cardiac anomalies includes the following:
Transposition of the Great Arteries (TGA)
Atrioventricular Septal Defect (AVSD)
Tetralogy of Fallot (TOF)
Hypoplastic Left Heart Syndrome (HLHS) 50
Bilateral renal agenesis 84
Lethal skeletal dysplasia
Edwards’ syndrome (Trisomy 18)
95**
Patau’s syndrome (Trisomy 13)
**Detections rates will be reviewed following implementation of screening as part of the combined screening strategy
FASP UK Fetal cardiac training project

8. FASP Ultrasound Images to archive
Local protocols may have additional requirements for example placental site, amniotic volume etc
FASP UK Fetal cardiac training project

9. NCARDRS
The National Congenital Anomaly and Rare Disease Registration Service (NCARDRS) records those people with congenital abnormalities and rare diseases
Historically 49% of births were monitored by 7 regional registers.
Unable to provide comprehensive outcome data for screening programmes in England
Capture data from all of England Via 9 regional centres
timely data collection
local and national data feeds
improved quality assurance
Benefits to individual patients, their families
FASP UK Fetal cardiac training project

10. Performance thresholds
Acceptable: Detection rate ≥50% for each serious cardiac anomaly shown above.
Fetal Anomaly Screening Programme Standards p 12;
This is the area that detection rate needs improving
FASP UK Fetal cardiac training project

11. FASP-Fetal Cardiac Protocol Rationale, Training and Implementation for the 3VT view

12. FASP Fetal Cardiac Protocol
Smart Survey 2012 Recommendations by the FASP fetal cardiac expert working group Evidence supports that routine examination of the fetal heart using additional 3VV and 3VT views will improve detection rates for cardiac anomalies Particularly duct dependent abnormalities Benefits Ensure babies get appropriate and timely care after birth Increase the national detection rate of major cardiac abnormalities give parents earlier choice regarding the pregnancy options
FASP UK Fetal cardiac training project

13. FASP Fetal Cardiac Protocol
FASP UK Fetal cardiac training project

14. Training Needs Analysis
Questionnaire survey carried out in May 2014
Web based survey
143 trusts across England were invited via screening support sonographers and screening support midwives
123 trusts responded (86%)
All regions responded with a regional spread in non responders or no data.
FASP UK Fetal cardiac training project

15. Which region is your screening unit based?
FASP UK Fetal cardiac training project

16. Information gathered
How many individual sonographers offer weeks scan? What current practice for fetal cardiac examinations in their trusts? What theoretical training provision they currently accessed? What practical training for the fetal cardiac views did they access especially the 3VV AND 3VT view What requirements they needed for further training
FASP UK Fetal cardiac training project

17. Summary of results
Majority of trusts (75%) were already incorporating 3 vessel views in their fetal cardiac survey. Small percentage (7%) currently using 3 Vessel and Trachea view (3VT). 62% indicated they required full training and 33% require refresher training. 85% use FASP/FMF basic on-line resource for their theory training. Just under half of trusts (49.66%) are using in house training. Most effective way of training is a combination of on-line training and practical in house training via nominated cardiac “Champions”
FASP UK Fetal cardiac training project

18. The project and training team
FASP UK Fetal cardiac training project

19. Cardiac champions
Local nominated sonographer Training support to develop and enhance skills in fetal cardiac scanning Will work with local sonographers to identify learning needs Cascade training to sonographers in their Trust Provide feedback to sonographers to review techniques and improve standards Liaise with other champions Named contact for tertiary referrals Improve communication
FASP UK Fetal cardiac training project

20. Planned Fetal cardiac training
FASP UK Fetal cardiac training project

21. Regional workshops
Each trust nominate a cardiac sonographer to act as “Champion” Champions invited to attend regional workshop/s Lectures/forum to support New standards and evidence of detection rates Challenges & Solutions Identify practical session needs and support Opportunity to establish regional and national fetal cardiac networks Sharing experiences Resource package will be developed
FASP UK Fetal cardiac training project

22. Fetal cardiac and 3VT e-learning
Champions were required to complete on line training before commencing practical training
FASP UK Fetal cardiac training project

23. Regional workshops
Champions were invited to attend regional workshop/s Lectures/forum to support New standards and evidence of detection rates Challenges & Solutions Identify practical session needs and support Opportunity to establish regional and national fetal cardiac networks Sharing experiences Resource package was developed
FASP UK Fetal cardiac training project

24. Theory day
FASP UK Fetal cardiac training project

25. Practical “hands on” training day
Pregnant women recruited
Delegates worked in pairs
Each delegate had opportunity to scan at least 4 women
Each delegate had opportunity to work with at least 2 trainers
Signed off by trainers and given certificate of attendance
FASP UK Fetal cardiac training project

26. Additional resources
FASP UK Fetal cardiac training project

27. Theoretical and Practical “hands on” training

28. Sonography training for the 3VT
FASP UK Fetal cardiac training project

29. Sonography training for the 3VT
FASP UK Fetal cardiac training project

30. Evaluation of 3VT training

31. Project evaluation
The overall objective of the project was to support the training of sonographers to enable them to incorporate fetal cardiac outflow tract views as a routine element of the 18 to 20+6 week anomaly scan. Evaluation of theory and practical days Monitor the implementation of the cardiac protocol Longer term objectives were also identified i.e. To evaluate the detection rate of cardiac anomalies at the anomaly scan after the incorporation of the additional 3VT view. To evaluate the referral rates and the false positive results on local and tertiary service provision. To obtain data for the FASP four main conditions Atrioventricular Septal Valve Defect(AVSD), Hypoplastic Left Heart Syndrome (HLHS), Tetralogy of Fallot (TOF) and Transposition of the Great Arteries(TGA).
FASP UK Fetal cardiac training project

32. Feedback on theory and practical days
FASP UK Fetal cardiac training project

33. Training evaluation
FASP UK Fetal cardiac training project

34. Implementation of FASP cardiac protocol

35. Implementation process
FASP UK Fetal cardiac training project

36. 1st January 2017
139 (96%) had implemented, 5 Trusts still to implement
FASP UK Fetal cardiac training project

37. 1st April 2017
142 (98.5 %) have implemented 2 trusts still to implement
FASP UK Fetal cardiac training project

38. Examples of how Trusts implemented the 3VT View

39. Examples of sharing knowledge
Self assessments for learning needs One to one training Peer training Group reviews Regular feedbacks Image audits 3VT images stuck on notice board for dissemination. Visits to tertiary centres
FASP UK Fetal cardiac training project

40. Image audits
FASP UK Fetal cardiac training project

41. Thank you any questions ?