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About Us

INSIGHT - A new approach to ultrasound

The INSIGHT Study is a research program aimed at developing a new approach to using ultrasound in a safe and effective way to improve supportive care during critical illness. INSIGHT provides a new paradigm for the use of ultrasound technology.

Our Story

INSIGHT began more than 15 years ago when it became clear that ultrasound technology was likely to advance on several clinical technology fronts. This includes miniaturisation; non-Piezo crystal ultrasound sources; improved interoperability in relation to image storage and accessibility; and improved standards of training and governance. Ultrasound was, and is, also being used outside conventional radiological services, by a variety of healthcare professionals, particularly in the emergency setting. 

Our intervention

The INSIGHT Intervention

INSIGHT involves 

  1. A simple ultrasound protocol that can be delivered rapidly in a constrained bed space in complex workflow

  2. A protocol that yields maximum benefit for minimum effective ultrasound windows

  3. A protocol that supports interprofessional application and interpretation of ultrasound (including common language and reporting format)

  4. A protocol that is embedded in critical care workflow and the patient record

  5. A protocol that permits immediate access to images to help link to decision making

  6. A protocol that has robust safety and quality measures including around training

  7. A protocol that uses scheduled/planned ultrasound assessment (not in response to a cardiac arrest/acute haemodynamic instability/emergency assessment of a new or unstable patient/to assist in invasive procedures)

INSIGHT design?

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Why Interprofessional?

Nurses are at their patient's bedside and already manage complex devices, assessments, and interventions. For example, ventilation, renal replacement, and complex haemodynamic support. 

Physiotherapists routinely carry out advanced airway clearance procedures and are often the first to mobilise a recovering patient. This scan can serve as a pre and post intervention assessment.

ACCPs, nurses, and doctors carry out full body assessments of their patients and would use this scan to complement the A, B, C, D, E assessment and help inform clinical decision making.

The concept of a shared platform could enhance communication, improved relationships and understanding between staff professions.


Why research?

Bedside ultrasound has proven to be as accurate as CT scans and chest x-rays and but what we don't know is if we train multiple staff groups in INSIGHT to make ultrasound more available to more patients, could it improve patient outcomes? Could it reduce the time spent on mechanical ventilation? Could it reduce the number of x-rays and transfers a patient needs? could it speed up treatment times by identifying or confirming concerns without the wait for out of department investigations? We have established equipoise and strong support among clinicians in our trust. As this is an unproven complex intervention with a requirement to develop the intervention (particularly around training; and demonstrate clinical effectiveness (patient outcomes/health economic), there is a clear need to carry out our research in stages to make sure it is conducted safely and with high quality data.. 

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Why do we focus on training?

Adequate training and appropriate governance of staff training is at the core of ensuring patient safety. The existing evidence base widely reports that less one third of staff that start ultrasound training go on to complete it. Leaving a huge proportion of staff only partially trained but potentially still performing scans in the workplace. In addition, there is no mandate to maintain ultrasound skills once accredited through refresher sessions or ongoing supervision. We want to address these widespread issues in our research. By focusing on training, we hope to gain traction and momentum for the use of INSIGHT across our ICUs. This should lead to embedding INSIGHT as part of routine clinical workflow and contribute to changes in patient management


Why ultrasound?

Ultrasound is immediate, meaning images can be seen and assessed in real time. It doesn't involve ionising radiation like CT scans or X-rays, and has been found to be as accurate as other types of scans which means it could reduce the need for them, minimising unnecessary radiation and reducing healthcare costs. Ultrasound is rapidly repeatable, cheap to use, and can be performed in situ at the patient's bedside with no requirement for patient transport. This could reduce waiting times for treatment, decrease the risks associated with transporting the patient, and allow for uninterrupted care.


Why ICU?

The ICU environment demands continuous high quality care, assessment and treatment of the critically ill patient, regardless of whether it is day or night. Beside ultrasound has been established for rapid assessment in the emergency department (in the settings of cardiac arrest, shock, or internal bleeding, among others) and could help improve the safety and efficacy of invasive procedures (vascular access/chest drain insertion) whilst minimising the risk of infection.


Is INSIGHT supported by our patients and their loved ones?

Our patient and public group strongly support the clinical relevance of ultrasound that is nurse-led. They like the avoidance of ionising radiation and the immediate availability of the imaging. We designed our study outcomes to reflect what our patient and public group thought were the most important to them and their families. For example, a strong view was the experience of being transferred out of ICU for a CT or MRI scan was scary and the scanner itself is very noisy. If INSIGHT could reduce the need for this, it could improve patient experience and wellbeing. Our study therefore decided to measure the number of scans in a group of ICU patients receiving INSIGHT compared to a group of patients not receiving INSIGHT.


The INSIGHT research team are based in King's Critical Care with strong links to King's Health Partners Academic Health Sciences Centre and King's College London. King's Critical Care are one of the largest critical care services in the United Kingdom with a wide casemix comprising Major Trauma, Specialist Liver and Upper GI services; Stroke and Neurosciences; Transplantation (Solid Organ & Haem-Onc); Cardiac Sciences including Cardiac Arrest Centre as well as close links to South London & Maudsley mental health services. 

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