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Point | Counterpoint – POCUS Does Not Need Credentialing

April 9, 2020

Written by Clay Smith

Spoon Feed
These authors think point-of-care ultrasound (POCUS) should not require special institutional credentialing or privileging, as it is non-invasive, easy to learn, and nearly ubiquitous in residency and critical care medicine (CCM) training.

Why does this matter?
Yesterday we covered the argument for credentialing POCUS. What’s the other side of this?

Anti-red tape
They open by stating, “the key question is whether diagnostic POCUS should be treated as one of these ‘special’ skills outside the core set of critical care privileges that requires specific oversight and regulation.” They note that core privileges for CCM, “include the performance of standard ancillary diagnostic and therapeutic procedures within the discipline.” They consider POCUS one of them. Any procedures that require special privileging, such as tracheostomy, burr holes, rigid bronchoscopy, or balloon pump placement are invasive, risky, and require a special skill set. POCUS is non-invasive, and multiple studies have shown that with minimal training, intensivists can acquire and interpret these studies. They argue these physicians know when more formal assessment is necessary and will order appropriate imaging in radiology when needed. Many view POCUS as a physical exam extension. They also note that POCUS is, in fact, widely taught as part of a core CCM educational curriculum and that many doing CCM fellowships already have extensive POCUS experience in residency. They think the increased regulatory burden will adversely impact patient care by stripping this tool from clinicians at the bedside. What’s your opinion after reading both sides? Drop a comment.

COUNTERPOINT: Should the Use of Diagnostic Point-of-Care Ultrasound in Patient Care Require Hospital Privileging/Credentialing? No. Chest. 2020 Mar;157(3):498-500. doi: 10.1016/j.chest.2019.10.037.

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What are your thoughts?