Implementing a quality framework for storing emergency department point-of-care ultrasound examinations on a picture archiving and communication system

Abstract

Introduction There is a lack of a quality framework in most emergency departments despite the set national standards for storing point-of-care ultrasound (PoCUS) examinations. To explore and address this problem, a quality improvement project was undertaken in an emergency department. Methods and interventions: A consecutive sample of the most recent PoCUS examinations in a district general hospital emergency department in the United Kingdom was audited. None was handled and stored on the picture archiving and communication system (PACS). Quality improvement project tools, such as plan, do, study, act (PDSA) cycles, were utilised to analyse and improve practice. The PoCUS machine was connected to the local area network to allow transfer of images to PACS. For requesting and booking the examinations, specific requests on the integrated clinical environment were created akin to the computerised radiology information system codes. Other interventions were introduced such as a reporting proforma. The success of the quality improvement project depended partly on key stakeholders such as emergency department consultants, radiology staff and PACS teams. The number of stored examinations on PACS was the main process measure, but others were also considered, for example reporting and documentation. Results Over a 10-month period (September 2018–July 2019), there were three PDSA cycles, which included a total of 195 performed emergency department PoCUS examinations. The implemented quality framework led to 90% of examinations stored to PACS, with a mean of 63%. No negative impacts were reported, and feedback was positive. Conclusion Implementing a quality framework for storing emergency department PoCUS examinations on PACS is feasible and significantly improves practice. Further work is required to sustain and improve the process.

Point‐of‐care ultrasound in clinical assessment of acute urological emergencies

“…39 Despite challenges in delivering this infrastructure, audit and quality improvement projects demonstrate that this standard is feasible. 42 As new potential applications of POCUS emerge, the clinical scientific community should consider robust assessment of its performance, accuracy and role with prospective trials or registries before adoption into routine clinical…”

“…Well maintained and modern equipment connected to a central network for archiving saved images and reports, with regular quality assurance are the cornerstone of POCUS infrastructure and administration 39 . Despite challenges in delivering this infrastructure, audit and quality improvement projects demonstrate that this standard is feasible 42 …”

A Clinician’s Guide to the Implementation of Point-of-Care Ultrasound (POCUS) in the Outpatient Practice

“…Best practices in POCUS use include capabilities for archiving images in the electronic health record, regardless of intent to bill, for the sake of quality of care. 23 , 46 , 47 Saved images should include sufficient labeling to include organ/tissue/body region imaged if not obvious and laterality when appropriate in addition to patient identifiers. Whenever possible, ongoing competence should be assessed through periodic image review by POCUS experts, which can be incorporated into credentialling/recredentialling processes.…”

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“…Аналогичное исследование по внедрению практики сохранения УЗИ-данных в отделения неотложной помощи было проведено Mani N. Для достижения поставленной цели аппарат для проведения POCUS был подключен к локальной сети для обеспечения передачи изображений в PACS, АНАЛИТИЧЕСКИЙ ОБЗОР а также были созданы отчетные формы и предоставлен доступ к компьютеризированной радиологической информационной системе для корректного сохранения данных. За 10 месяцев работы с новой системой были сохранены до 90% исследований в PACS, оценка врачей данной практики была положительной [79].…”