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Point | Counterpoint – POCUS Needs Credentialing

April 8, 2020

Written by Clay Smith

Spoon Feed
Since critical care medicine (CCM) programs do not have explicit training requirements or standards for point-of-care ultrasound (POCUS), these authors think that an institution should prove competence through credentialing and privileging (c/p).

Why does this matter?
First, some definitions: ”Credentialing is the process of ‘obtaining, verifying, and assessing the qualifications of a practitioner to provide care or services in or for a health-care organization…;‘ privileging is the ‘process of authorizing a specific scope of practice for patient care based on credentials and performance.’” Should c/p required for POCUS?

Pro-red tape
These authors argue that c/p should be required because incompetence with POCUS could be dangerous and lead to incorrect clinical decisions based on flawed imaging acquisition or interpretation. Since CCM programs do not have specific POCUS standards, unlike EM or anesthesia, they advocate for a defined c/p process for critical care. They note that, “50% of pulmonary CCM fellowship training programs lacked a formal POCUS curriculum” and state that, “If all CCM training programs met this standard, then health-care institutions hiring new graduates could feel comfortable forgoing POCUS privileging because completion of an accredited CCM training program would be a sufficient proxy for competence.” Since they do not, they argue that an institution must prove competence and provide privileging.

POINT: Should the Use of Diagnostic Point-of-Care Ultrasound in Patient Care Require Hospital Privileging/Credentialing? Yes. Chest. 2020 Mar;157(3):496-498. doi: 10.1016/j.chest.2019.10.041.

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What are your thoughts?