369 A Survey Evaluation of Barriers to Provider Compliance With Point-of-Care Ultrasound Documentation

Saul, Turandot; Siadecki, Sebastian D.; Rose, Gabriel; Berkowitz, Robert

doi:10.1016/j.annemergmed.2016.08.386

Cited by 12 publications

(11 citation statements)

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“…The most significant barriers to POCUS in high income countries are time constraints with suggested improvements targeting improving the workflow and incorporation of the PoCUS documentation into the electronic medical records. [21] The aim of the study was to explore the perception of clinicians regarding performing PoCUS in the acute care department, and to understand the facilitators and constraints of incorporating PoCUS into patient investigation pathways at a teaching and referral hospital in a low resource setting.…”

Section: Introductionmentioning

confidence: 99%

Point of care ultrasound in acutely breathless patients-A qualitative study of the enablers and challenges in a teaching hospital in Kenya

Kagima

Masheti

Mbaiyani

et al. 2021

JPATS

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Objectives: Acute breathlessness is a common and distressing symptom experienced by patients presenting to the emergency department (ED). Adoption of clinician-performed bedside ultrasound could promote accurate, early diagnosis and treatment to acutely breathless patients. This may be particularly pertinent in low resource settings with limited human resources and lack of access to advanced (gold standard) diagnostic testing. The aim of the study was to explore the experience of point-of-care ultrasound (PoCUS) users in the emergency department, and to understand the facilitators and constraints of PoCUS incorporation into patient investigation pathways. Materials and Methods: This was an exploratory qualitative study. Data collection entailed key informant interviews using a semi-structured interview guide between September 2019 and February 2020. Participants were purposively sampled according to role and responsibility in the acute care system at Kenyatta National Hospital, including front-line health practitioners and mid-level clinical hospital managers. Data collection proceeded until no new concepts emerged (thematic saturation). The analytical framework method was used for the thematic analysis of interview transcripts. Results: At individual level, the lack of training on the use of PoCUS, as well as fears and beliefs impacted on capability and motivation of the clinicians to perform PoCUS for clinical diagnosis. Hospital level influencers such as hospital norms, workloads, and staffing influenced the use of PoCUS by impacting on the clinician’s capability, motivation, and opportunity. General health system influencers such as relationships and power dynamics between clinical specialties and key stakeholders, and the lack of policy and practice guidelines challenged the uptake of the bedside ultrasound by the clinicians. Conclusion: Lack of PoCUS training for clinicians, limited resources and a fragmented health system structure impacted the clinician’s capability, motivation, and opportunity in performing PoCUS in diagnostics. PoCUS for diagnosis of acute breathlessness requires: (1) Well-maintained and accessible equipment; (2) highly trained individuals with time to perform the examination with access to ongoing support for the operators; and (3) finally, researchers must more accurately identify the optimal scope of ultrasound examination, the diagnostic benefits, and the opportunity costs. All three will be required to ensure patient’s benefit.

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Section: Introductionmentioning

confidence: 99%

Point of care ultrasound in acutely breathless patients-A qualitative study of the enablers and challenges in a teaching hospital in Kenya

Kagima

Masheti

Mbaiyani

et al. 2021

JPATS

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“…Beyond simply encouraging use, incomplete documentation of completed POCUS studies presents an There is some evidence that financial incentives may be a favored reward for POCUS use and documentation among physicians, though enhanced education and training have also been described as beneficial interventions [8,9]. The most efficacious route to enhance physician use and documentation of POCUS remains to be determined.…”

Section: Introductionmentioning

confidence: 99%

Description of the Use of Incentives and Penalties for Point-of-Care Ultrasound Documentation Compliance in an Academic Emergency Department

Melton

Rupp

Blatt

et al. 2021

Cureus

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Incomplete documentation and submission to the electronic health record of performed point-of-care ultrasound (POCUS) studies is problematic from a patient care, medicolegal, and billing standpoint. Positive and negative financial incentives may be used to motivate physicians to complete documentation workflow. The most efficacious route to improve POCUS workflow completion remains to be determined. Materials and methodsA retrospective analysis of POCUS documentation in an academic emergency department during four distinct six-month blocks was performed. POCUS workflow completion was assessed without incentives (Baseline), with financial bonus (Incentive), interim period (Washout), and with a negative financial incentive (Penalty) to determine the effect of these incentives on workflow completion. ResultsThere was an appreciable increase in the rate of POCUS studies documented between the "Baseline" (no incentive) and "Incentive" (small financial bonus) time periods. The improvement remained stable during the "Washout" (interim) period, and then increased further in the "Penalty" (negative financial incentive) period. This improvement was relatively diffuse among the providers studied. A similar patternimprovements in the Incentive and Penalty periods with stability in the Washout -was also observed in the POCUS volume data (number of studies performed). ConclusionsThis study reveals a positive association between the implementation of both financial incentives and financial penalties, which increases in POCUS documentation among attending physicians at an academic emergency department.

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“…A survey done by Shah et al also found a lack of training and the equipment cost to be the primary barrier to the use of USG. 24 Another study 25 showed that the most significant barriers to POCUS documentation were time constraints, the existence of a separate computer program for POCUS documentation, and problems with the USG machines. One significant barrier according to a pilot study 26 relates to the need for dedicated time to learn and practice POCUS to achieve sufficient levels of proficiency for use in practice.…”

Section: Discussionmentioning

confidence: 99%

<p>Evaluation of Interdisciplinary Emergency Ultrasound Workshop for Primary Care Physicians in Nepal</p>

Shrestha¹,

Blank²,

Shrestha³

et al. 2020

OAEM

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Point-of-care ultrasound (POCUS) is a quick bedside tool that has the potential to improve emergency care in resource-limited settings due to its relatively low cost and accessibility. Effort to disseminate the knowledge and skills about POCUS is inadequate in low and middle income countries like Nepal. We conducted a two-day interdisciplinary advanced emergency ultrasound workshop that targeted physicians working in emergency department and primary care, especially in rural Nepal. We explored the effectiveness of this training based on validated Kirkpatrick's 4 steps of evaluating training outcomes. Materials and Methods: We conducted a prospective quasi-experimental study with mixed research design. Multidisciplinary physicians working in emergency departments participated in the two-day workshop. We assessed and compared the pre-and post-workshop knowledge. We collected on-site and a follow-up feedback to explore pre-and post-workshop confidence level, perceived usefulness and clinical use of ultrasound using a 5-point Likert scale. The barriers to use POCUS were explored. Results: A total of 50 physicians from different parts of Nepal participated in the workshop. The academic level of the participants, duration of their clinical experience and the previous use of POCUS did not have a significant difference in their pre-and posttest knowledge scores. The difference between the median (IQR) pre-and posttest scores [14 (12.75-17.75) and 24.5 (22.25-25.5), respectively] was statistically significant (p<0.001). Perceived confidence level and usefulness of the POCUS increased significantly in all of its domains (p<0.001). Self-reported increase in its clinical use was significant (p<0.001) for all fields. Conclusion: The participation in this emergency ultrasound workshop increased the knowledge of participants in POCUS. Their confidence, perceived usefulness and clinical use of POCUS improved significantly. Objective longitudinal follow-up of participants' skill and demonstration of increased clinical use of POCUS in emergency department influencing the clinical outcome would be the focus of future research.

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369 A Survey Evaluation of Barriers to Provider Compliance With Point-of-Care Ultrasound Documentation

Cited by 12 publications

References 0 publications

Point of care ultrasound in acutely breathless patients-A qualitative study of the enablers and challenges in a teaching hospital in Kenya

Point of care ultrasound in acutely breathless patients-A qualitative study of the enablers and challenges in a teaching hospital in Kenya

Description of the Use of Incentives and Penalties for Point-of-Care Ultrasound Documentation Compliance in an Academic Emergency Department

<p>Evaluation of Interdisciplinary Emergency Ultrasound Workshop for Primary Care Physicians in Nepal</p>

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