A majority of rural emergency departments in the province of Quebec use point-of-care ultrasound: a cross-sectional survey

Abstract

BackgroundPoint-of-care ultrasound (POCUS) can be used to provide rapid answers to specific and potentially life-threatening clinical questions, and to improve the safety of procedures. The rate of POCUS access and use in Canada is unclear. The objective of this study was to examine access to POCUS and potential barriers/facilitators to its use among rural physicians in Quebec.MethodsThis descriptive cross-sectional study used an online survey. The 30-item questionnaire is an adapted and translated version of a questionnaire used in a prior survey conducted in rural Ontario, Canada. The questionnaire was pre-tested for clarity and relevance. The survey was sent to non-locum physicians working either full- or part-time in rural emergency departments (EDs) (n = 206). All EDs were located in rural and small towns and provided 24/7 medical coverage with acute care hospitalization beds.ResultsIn total, 108 surveys were completed (participation rate = 52.4 %). Of the individuals who completed surveys, ninety-three percent were family physicians, and seven percent had Canadian College of Family Physicians – Emergency Medicine (CCFP-EM) certification. The median number of years of practice was seven. A bedside ultrasound device was available in 95 % of rural EDs; 75.9 % of physicians reported using POCUS on a regular basis. The most common indications for POCUS use were to rule out abdominal aortic aneurysm (70.4 %) and to evaluate presence of free fluid in trauma and intrauterine pregnancy (60 %). The most common reason (73 %) for not using POCUS was limited access to POCUS training programs. Over 40 % of POCUS users received training in POCUS during medical school or residency. Sixty-four percent received training from the Canadian Emergency Ultrasound Society, 13 % received training from the Canadian Association of Emergency Physicians, and 23 % were trained in another course. Finally, 95 % of respondents reported that POCUS skills are essential for rural ED practice.ConclusionsPOCUS use in rural EDs in the province of Quebec appears to be relatively widespread. Access to training programs is a barrier to greater use.

Barriers to point-of-care ultrasound use in rural emergency departments

“…16 In stark contrast to Ontario and Newfoundland, a survey of rural ED physicians in Quebec by Léger et al in 2014 revealed that PoCUS was available in 95% of rural EDs. 17 Variable access to bedside ultrasound in rural EDs also exists in the United States. One survey of ED directors in Colorado, Georgia, Massachusetts, and Oregon reported that only 39% of rural EDs had access to bedside ultrasound.…”

“…16 Léger et al discovered that 95% of respondents believed that PoCUS was essential for rural ED practice, but 24% of physicians did not use PoCUS on a regular basis with the most common reason for lack of use being limited access to training programs. 17 In the WWAMI region of the United States, 62% of surveyed rural physicians identified a lack of training as a barrier to PoCUS use, with 35% having difficulty with image interpretation. A majority of these physicians (80%) were interested in a PoCUS course if offered at their site with many (64%) also being interested in a distance learning program.…”

“…Of the Quebec physicians working in rural EDs responding to Léger et al, 93% were family physicians. 17 The American Academy of Family Physicians (AAFP) released a statement in 2013 addressing ultrasound use as an area of competency for rural family physicians, but the College of Family Physicians of Canada has yet to make a similar statement for Canadian family physicians. 28 Despite the statement made by the AAFP, in 2014 the Council of Academic Family Medicine Educational Research Alliance surveyed family medicine residency program directors to discover that only 2% of residency programs reported an established ultrasound curriculum.…”

A Canadian Rural Living Lab Hospital: Implementing solutions for improving rural emergency care

“…Our study showed that 75% of rural ED physicians believed that POCUS was an essential tool and skill to master in rural EDs, but few physicians use it regularly. 41 Learning its use is difficult due to little access to continuing medical education.…”

Peer-Led Point-of-Care Ultrasound; A Potential Ally to Rural Medicine

“…In parallel, POCUS' clinical implementation, as an extension of the physical exam in rural medicine is steadily increasing (33). This is reflected by the recent surge of generalist/specialist and rural health care facilities purchasing POCUS equipment (34)(35)(36). Thus, with limited access to other formal imaging diagnostic modalities, POCUS has become an attractive ally to rural medicine.…”