Current use, training, and barriers in point‐of‐care ultrasound in hospital medicine: A national survey of VA hospitals

Abstract

Background: Point-of-care ultrasound (POCUS) can reduce procedural complications and improve the diagnostic accuracy of hospitalists. Currently, it is unknown how many practicing hospitalists use POCUS, which applications are used most often, and what barriers to POCUS use exist. Objective: This study aimed to characterize current POCUS use, training needs, and barriers to use among hospital medicine groups (HMGs). Design, Setting, and Participants: A prospective observational study of all Veterans Affairs (VA) medical centers was conducted between August 2019 and March 2020 using a web-based survey sent to all chiefs of HMGs. These data were compared to a similar survey conducted in 2015. Result: Chiefs from 117 HMGs were surveyed, with a 90% response rate. There was ongoing POCUS use in 64% of HMGs. From 2015 to 2020, procedural POCUS use decreased by 19%, but diagnostic POCUS use increased for cardiac (8%), pulmonary (7%), and abdominal (8%) applications. The most common barrier to POCUS use was lack of training (89%), and only 34% of HMGs had access to POCUS training. Access to ultrasound equipment was the least common barrier (57%). The proportion of HMGs with ≥1 ultrasound machine increased from 29% to 71% from 2015 to 2020. An average of 3.6 ultrasound devices per HMG was available, and 45% were handheld devices. Conclusion: From 2015 to 2020, diagnostic POCUS use increased, while procedural use decreased among hospitalists in the VA system. Lack of POCUS training is currently the most common barrier to POCUS use among hospitalists.

Point of Care Ultrasound (POCUS) Utilization and Barriers by Senior Emergency Medicine and Critical Care Residents at Two Teaching Referral Hospitals, Addis Ababa, Ethiopia

“…Lack of ultrasonography, a lack of organized curriculum, a lack of a national standard, and a lack of training were the top barriers to US usage raised by residents. Lack of ultrasound equipment used to be a signifcant issue when POCUS frst began in the West, but lack of training was also a signifcant issue in other nations [19][20][21][22].…”

Use of Artificial Intelligence for Acquisition of Limited Echocardiograms: A Randomized Controlled Trial for Educational Outcomes

“…As POCUS usage continues to expand, 7,19 AI-enabled devices represent a possible means to enhance competency among novice users and aid in interpretation. 13,14,20 In this randomized, controlled trial, we observed that internal medicine residents randomized to carry an AI-POCUS device for two weeks without feedback were able to obtain A4C views more quickly, had higher A4C image quality scores, and were more likely to identify reduced systolic function compared to residents who carried non-AI devices.…”

“…[1][2][3][4][5] In response to the growing evidence supporting the use of POCUS for patient care, medical schools, residency programs, and professional societies have developed training programs for its safe and effective usage. [5][6][7] In addition, several organizations have established guidelines in an effort to standardize POCUS training. 3,8 Barriers to implementing more universal training measures include time constraints within training programs, a paucity of faculty credentialed for supervision, limiting funding, the need for established quality assurance protocols, and a lack of standardized assessments.…”

“…3,8 Barriers to implementing more universal training measures include time constraints within training programs, a paucity of faculty credentialed for supervision, limiting funding, the need for established quality assurance protocols, and a lack of standardized assessments. 1,6,7,9 Due to these barriers, novice users continue to use POCUS with minimal training and oversight, 5,10 thus underscoring the need for alternative training methods with this ever-growing technology.…”

Maximizing impact of faculty development through purposeful design: Lessons from a quality and safety education academy

“…New training needs are regularly identified in the modern clinical environment, and faculty workforce development remains challenging. Within the sphere of hospital medicine some recent calls include health and healthcare equity improvement, 14 addiction medicine, 15 and point‐of‐care ultrasound 16 . As experts respond to these needs and train‐the‐trainer models are designed, we recommend they consider the following based on our experience: …”