Critical care ultrasound was widely reported across participating hospitals in Sichuan Province, China, but its application varied according to hospital level, clinical condition, and operator experience. In a cross-sectional survey across 212 institutions, nominal hospital-level differences were identified across several conditions, though only stroke remained statistically significant after false discovery rate adjustment.

Critical care ultrasound delivers real-time bedside diagnostic and monitoring information to guide the immediate management of critically ill individuals. However, real-world implementation often encounters disparities linked to institutional resources, clinicians’ accumulated experience, and access to educational infrastructure. To assess these dynamics, researchers affiliated with the Committee on Critical Care Ultrasound and Hemodynamics of the Sichuan International Medical Exchange and Promotion Association examined clinician-reported practices and explored their associations with hospital level and operator experience.

The investigation utilized a cross-sectional online survey administered between June and July 2023 via the Questionnaire Star platform. To rigorously evaluate the survey responses, the analytical team applied descriptive statistical frameworks alongside cumulative link mixed models featuring hospital-specific random intercepts. This statistical modeling allowed the researchers to adjust for institutional clustering while systematically comparing disease-specific ultrasound utilization patterns across various hospital tiers.

The study cohort comprised 1,014 clinical respondents representing 212 separate medical institutions across Sichuan Province. When stratified by institutional classification, 67.26 percent of respondents were from tertiary Grade A hospitals. An additional 24.95 percent of respondents worked in tertiary Grade B hospitals, while 7.79 percent were based in secondary hospitals.

In cluster-adjusted ordinal analyses evaluating specific clinical indications, researchers noted nominal differences across hospital tiers in the reported application of critical care ultrasound for conditions including traumatic brain injury, acute pancreatitis, post-cardiac arrest resuscitation, and stroke. However, after applying the Benjamini-Hochberg false discovery rate correction to adjust for multiple testing, only the institutional variation in ultrasound utilization for stroke maintained formal statistical significance.

Critical care ultrasound application also varied according to operator experience. Physicians with longer critical care ultrasound experience generally reported higher disease-specific application scores. Physicians with longer experience also reported more frequent clinician-reported changes in diagnostic decision-making.

Despite the wide reported presence of critical care ultrasound across Sichuan hospitals, participants highlighted substantial operational obstacles, including acute shortages of qualified personnel, insufficient ultrasound equipment, limited access to structured training programs, and persistent difficulties with image interpretation. Consequently, more than 90 percent of surveyed clinicians across all hospital levels expressed a clear demand for further ultrasound education. The authors emphasized that addressing these barriers requires tiered competency-based training curricula alongside robust quality-control mechanisms, while noting that future prospective investigations evaluating patient-level clinical outcomes are essential to definitively determine the broader clinical efficacy of critical care ultrasound.

Subject of Research: Critical care ultrasound practice, institutional variation, and training needs across hospitals in Sichuan Province, China

Article Title: Critical care ultrasound practice, clinician-reported clinical contributions, and training needs across hospital levels in Sichuan Province, China: a cross-sectional survey of 212 hospitals

Article References: Zeng, X., Yin, W., Qin, Y., Wang, Y., Cao, L., Lei, X., Liao, X., Kang, Y., Committee on Critical Care Ultrasound and Hemodynamics (CCUSH) of Sichuan International Medical Exchange & Promotion Association (SCIMEA), Kang, Y., Huang, X., Jin, X., Yin, W., Wang, Y., Liao, X., Lei, X., Cao, L., Liang, G., Zeng, X., … Tang, X. (2026). Critical care ultrasound practice, clinician-reported clinical contributions, and training needs across hospital levels in Sichuan Province, China: a cross-sectional survey of 212 hospitals. BMC Health Services Research. https://doi.org/10.1186/s12913-026-16073-x

Image Credits: AI Generated

DOI: 10.1186/s12913-026-16073-x

Keywords: Critical care ultrasound, Point-of-care ultrasound, Sichuan Province, Intensive care medicine, Hospital tiers, Tertiary Grade A hospitals, Tertiary Grade B hospitals, Secondary hospitals, Clinical decision-making, Operator experience, Traumatic brain injury, Stroke assessment, Pancreatitis, Post-cardiac arrest, Bedside assessment, Cumulative link mixed models, Ultrasound training needs, Health services research