Prospective cohort study identifies barriers and facilitators to point-of-care ultrasound use in an academic emergency department.

BACKGROUND

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.

OBJECTIVES

The study objective identified barriers and facilitators to clinical POCUS use and performed an intervention to address these barriers.

METHODS

A prospective cohort study at a single academic hospital included emergency department attendings, residents and advanced practice providers (APPs). Participants were surveyed on perceived POCUS use barriers and facilitators (primary outcome). A multifaceted intervention from December 2023 to 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.

RESULTS

42/99 participants (42.4%) responded to surveys preintervention and 28 postintervention (28.3%). 56 physicians and 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'. Perceived POCUS facilitators included clear documentation protocols, hands-on teaching sessions and incentives for completing scans. Comfort in teaching diagnostic and procedural POCUS improved pre to postintervention but did not change for performing POCUS.

CONCLUSION

Identified barriers and facilitators were incorporated into a multifaceted intervention to improve clinical POCUS workflow processes. Future individualised interventions for low POCUS users and institutional initiatives with POCUS champions can be studied for improved patient care.