Prospective Cohort Study Identifies Barriers to Point-of-care Ultrasound use in an Academic Emergency Department
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Background/objectives
Point-of-care ultrasound (POCUS) improves patient care by expedited diagnosis and safer procedures. Despite POCUS benefits, some clinicians, including emergency physicians, do not readily use POCUS. The study objective identified barriers to clinical POCUS use and performed an intervention to address barriers and increase clinical POCUS use.
Methods
A prospective cohort study at a single academic hospital included ED attendings, residents, and advance practice providers (APPs). Participants were surveyed on perceived POCUS use barriers (primary outcome) and clinical POCUS were numbers recorded from July 2023-June 2024. A multi-faceted intervention from December 2023-January 2024 addressed identified barriers and involved: in-person POCUS education during shift by ultrasound faculty, clinical POCUS workflow demonstration during resident conference/faculty meetings, and QR code reference files on machines. Secondary outcomes were POCUS workflow knowledge exam scores, clinical ED POCUS scans performed, and revenue. Pre-/post-intervention analysis was performed using independent t-tests.
Results
42/104 ED providers (40.4%) responded to surveys pre-intervention and 28 post-intervention (28.3%). 56 physicians/APPs participated in the in-person POCUS intervention (17 attendings, 34 residents, 5 APPs). Perceived POCUS barriers were time constraints on shift; internet/connectivity problems and losing saved images; forgetting to finish exam worksheets online; images not uploading into Butterfly cloud by the end of shift; and residents performing “phantom scans”. Mean knowledge scores were 10/11 (89%), with 26/28 participants passing (score >90%). Participant self-perceived comfort in performing diagnostic and procedural POCUS increased (p=0.100, p=0.784 respectively). Procedural teaching comfort increased (p=0.022) but not diagnostic teaching (p=0.166). POCUS scan numbers increased from 1511 to 2130 (p=0.0035). Monthly POCUS revenue increased ~$55K in total billed (p=0.0439) and $10K reimbursed (p=0.1225).
Conclusion
Identified barriers were incorporated into a multi-faceted approach to improve clinical POCUS workflow processes, with increased ED POCUS use and revenue post-intervention. Future individualized interventions for low POCUS users and institutional initiatives with clinical champions can be studied for improved patient care.
