Written by Chris Thom
Spoon Feed
Insufficient time on shift and a lack of ongoing POCUS training form significant barriers to physician POCUS adoption.
Make POCUS easy, provide the training, and adoption will follow
POCUS is one of our most potent bedside tools in clinical medicine. It improves efficiency, saves lives, and makes us much more adept diagnosticians. Despite this, POCUS adoption remains variable amongst ED physicians. The current study investigated the key facilitators and barriers of POCUS adoption in a single academic tertiary care center. In a cohort of 91 eligible clinicians who had completed an ultrasound needs assessment survey, 29 were randomly chosen to participate in a series of structured interviews. These were split amongst 12 clinicians who held a high perceived POCUS usability, 9 with medium perceived usability, and 8 with low perceived usability. The most common facilitator to POCUS adoption identified was its ability to expedite patient care and provide additional data for decision making. Insufficient time on clinical shifts was a barrier to adoption, as was the need for confirmatory radiology-performed testing when POCUS was not definitive. Lack of adequate training and lack of confidence were also identified as POCUS barriers.
How will this change my practice?
ED physicians with specialized training in POCUS have a critical role to play in facilitating POCUS adoption. Thoughtful longitudinal instruction and adequate supervision are key roles for POCUS leaders to implement. Ultrasound machines should be easy to find and workflow should be as efficient as possible. Any extra steps will lead to reduced adoption; thus, POCUS workflow in particular should be continuously scrutinized. While the current study focused on an academic ED, the lessons here likely apply to community sites as well. In fact, one recent study notes that even the high POCUS utilizers in community EM were only performing 1.3 exams per 100 patients (1). Given this, we should continue to focus on novel ways to provide ongoing training and support, as well as to reduce the time needed on shift for POCUS exams to occur.
Source
Barriers and facilitators to point-of-care ultrasound use in an academic emergency department by perceived usability. Am J Emerg Med. 2024 Nov 23;88:105-109. doi: 10.1016/j.ajem.2024.11.056. Epub ahead of print. PMID: 39612527
Additional References
Smalley CM, Simon EL, Muir MR, Fertel BS. A Real-World Experience: Retrospective Review of Point-of-Care Ultrasound Utilization and Quality in Community Emergency Departments. West J Emerg Med. 2023;24(4):685-692.
