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Remskar MH, Theophanous R, Bowman A, Simonson LE, Koehler J, Basrai Z, Manohar CM, Mader MJ, Nathanson R, Soni NJ. Current Use, Training, and Barriers of Point-of-Care Ultrasound in Anesthesiology: A National Survey of Veterans Affairs Hospitals. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00229-X. [PMID: 37120325 DOI: 10.1053/j.jvca.2023.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVES The purpose of this study was to determine current use, training needs, and barriers to point-of-care ultrasound (POCUS) use among anesthesiologists in practice. DESIGN Multicenter, prospective, observational study. SETTING Anesthesiology departments in the Veterans Affairs Healthcare System in the United States. PARTICIPANTS Chiefs of staff and chiefs of anesthesiology departments. INTERVENTIONS A web-based survey was conducted between June 2019 and March 2020. Chiefs of staff answered questions about facility-level POCUS use, training, competency, and policies. Anesthesiology chiefs responded to a follow-up survey with specialty-specific POCUS questions. The results of the 2020 survey were compared with a similar survey conducted by the authors' group in 2015. MEASUREMENTS AND MAIN RESULTS All chiefs of staff (n = 130) and 77% of anesthesiology chiefs (n = 96) completed the survey. The most common POCUS applications used were central and peripheral vascular access (69%-72%), peripheral nerve blocks (66%), and evaluation of cardiac function (29%-31%). Compared with 2015, there was a statistically significant increase in desire for training (p = 0.00015), but no significant change in POCUS use (p = 0.31). Training was most desired for volume-status assessment (52%), left ventricular function (47%), pneumothorax (47%), central line placement (40%), peripheral nerve blocks (40%), and pleural effusion (40%). The most common barriers to POCUS use were lack of funding for training (35%), trained providers (33%), and training opportunities (28%). CONCLUSIONS A significant increase in desire for POCUS training was seen among anesthesiologists practicing in the Veterans Affairs healthcare system since 2015, and lack of training continues to be a top barrier for POCUS use among anesthesiologists.
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Affiliation(s)
- Mojca H Remskar
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN; Anesthesiology Service, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN.
| | - Rebecca Theophanous
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC; Emergency Medicine, Durham VA Healthcare System, Durham, NC
| | - Amber Bowman
- Department of Medicine, Duke University School of Medicine, Durham, NC; Medicine Service, Durham VA Healthcare System, Durham, NC
| | | | - Jessica Koehler
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI; Emergency Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Zahir Basrai
- Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Crystal M Manohar
- Department of Anesthesiology, University of Texas Health San Antonio, San Antonio, TX; Department of Anesthesiology Service, South Texas Veterans Health Care System, San Antonio, TX
| | - Michael J Mader
- South Texas Veterans Health Care System, Research Service, San Antonio, TX
| | - Robert Nathanson
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX; Department of Medicine, University of Texas Health San Antonio, San Antonio, TX
| | - Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX; Department of Medicine, University of Texas Health San Antonio, San Antonio, TX
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Resop DM, Basrai Z, Boyd JS, Williams JP, Nathanson R, Mader MJ, Haro EK, Drum B, O'Brien E, Khosla R, Bales B, Wetherbee E, Sauthoff H, Schott CK, Soni NJ. Current use, training, and barriers in point-of-care ultrasound in emergency departments in 2020: A National Survey of VA hospitals. Am J Emerg Med 2023; 63:142-146. [PMID: 36182580 DOI: 10.1016/j.ajem.2022.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Dana M Resop
- Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA; Emergency Department, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
| | - Zahir Basrai
- Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA; Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
| | - Jeremy S Boyd
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, TN, USA; VA Tennessee Valley Healthcare System-Nashville, Department of Emergency Medicine, Nashville, TN, USA.
| | - Jason P Williams
- Atlanta VA Medical Center, Medicine Service, Atlanta, GA, USA; Emory School of Medicine, Division of Hospital Medicine, Atlanta, GA, USA.
| | - Robert Nathanson
- South Texas Veterans Health Care System, Medicine Service, San Antonio, TX, USA; University of Texas Health San Antonio, Division of Hospital Medicine, San Antonio, TX, USA.
| | - Michael J Mader
- South Texas Veterans Health Care System, Research Service, San Antonio, TX, USA.
| | - Elizabeth K Haro
- South Texas Veterans Health Care System, Medicine Service, San Antonio, TX, USA; University of Texas Health San Antonio, Division of Hospital Medicine, San Antonio, TX, USA.
| | - Brandy Drum
- Healthcare Analysis and Information Group, Department of Veterans Affairs, Milwaukee, WI, USA.
| | - Edward O'Brien
- Healthcare Analysis and Information Group, Department of Veterans Affairs, Milwaukee, WI, USA.
| | - Rahul Khosla
- Department of Pulmonary, Critical Care and Sleep Medicine, The George Washington University, Washington, DC, USA; Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Washington, DC, USA.
| | - Brian Bales
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, TN, USA; VA Tennessee Valley Healthcare System-Nashville, Department of Emergency Medicine, Nashville, TN, USA.
| | - Erin Wetherbee
- Pulmonary Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
| | - Harald Sauthoff
- Medicine Service, VA NY Harbor Healthcare System, New York, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, NY, New York, USA.
| | - Christopher K Schott
- VA Pittsburgh Health Care Systems, Critical Care Service, Pittsburgh, PA, USA; University of Pittsburgh, Departments of Critical Care Medicine and Emergency Medicine, Pittsburgh, PA, USA.
| | - Nilam J Soni
- South Texas Veterans Health Care System, Medicine Service, San Antonio, TX, USA; University of Texas Health San Antonio, Division of Hospital Medicine, San Antonio, TX, USA; University of Texas Health San Antonio, Division of Pulmonary Diseases & Critical Care Medicine, San Antonio, TX, USA.
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Le MPT, Voigt L, Nathanson R, Maw AM, Johnson G, Dancel R, Mathews B, Moreira A, Sauthoff H, Gelabert C, Kurian LM, Dumovich J, Proud KC, Solis-McCarthy J, Candotti C, Dayton C, Arena A, Boesch B, Flores S, Foster MT, Villalobos N, Wong T, Ortiz-Jaimes G, Mader M, Sisson C, Soni NJ. Comparison of four handheld point-of-care ultrasound devices by expert users. Ultrasound J 2022; 14:27. [PMID: 35796842 PMCID: PMC9263020 DOI: 10.1186/s13089-022-00274-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background Point-of-care ultrasound (POCUS) is rapidly becoming ubiquitous across healthcare specialties. This is due to several factors including its portability, immediacy of results to guide clinical decision-making, and lack of radiation exposure to patients. The recent growth of handheld ultrasound devices has improved access to ultrasound for many clinicians. Few studies have directly compared different handheld ultrasound devices among themselves or to cart-based ultrasound machines. We conducted a prospective observational study comparing four common handheld ultrasound devices for ease of use, image quality, and overall satisfaction. Twenty-four POCUS experts utilized four handheld devices (Butterfly iQ+™ by Butterfly Network Inc., Kosmos™ by EchoNous, Vscan Air™ by General Electric, and Lumify™ by Philips Healthcare) to obtain three ultrasound views on the same standardized patients using high- and low-frequency probes. Results Data were collected from 24 POCUS experts using all 4 handheld devices. No single ultrasound device was superior in all categories. For overall ease of use, the Vscan Air™ was rated highest, followed by the Lumify™. For overall image quality, Lumify™ was rated highest, followed by Kosmos™. The Lumify™ device was rated highest for overall satisfaction, while the Vscan Air™ was rated as the most likely to be purchased personally and carried in one’s coat pocket. The top 5 characteristics of handheld ultrasound devices rated as being “very important” were image quality, ease of use, portability, total costs, and availability of different probes. Conclusions In a comparison of four common handheld ultrasound devices in the United States, no single handheld ultrasound device was perceived to have all desired characteristics. POCUS experts rated the Lumify™ highest for image quality and Vscan Air™ highest for ease of use. Overall satisfaction was highest with the Lumify™ device, while the most likely to be purchased as a pocket device was the Vscan Air™. Image quality was felt to be the most important characteristic in evaluating handheld ultrasound devices. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-022-00274-6.
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Multi-Level Stakeholder Perspectives on Determinants of Point of Care Ultrasound Implementation in a US Academic Medical Center. Diagnostics (Basel) 2021; 11:diagnostics11071172. [PMID: 34203357 PMCID: PMC8305030 DOI: 10.3390/diagnostics11071172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/11/2021] [Accepted: 06/22/2021] [Indexed: 12/23/2022] Open
Abstract
There is growing interest from multiple specialties, including internal medicine, to incorporate diagnostic point of care ultrasound (POCUS) into standard clinical care. However, few internists currently use POCUS. The objective of this study was to understand the current determinants of POCUS adoption at both the health system and clinician level at a U.S. academic medical center from the perspective of multi-level stakeholders. We performed semi-structured interviews of multi-level stakeholders including hospitalists, subspecialists, and hospital leaders at an academic medical center in the U.S. Questions regarding the determinants of POCUS adoption were asked of study participants. Using the framework method, team-based analysis of interview transcripts were guided by the contextual domains of the Practical Robust Implementation and Sustainability Model (PRISM). Thirty-one stakeholders with diverse roles in POCUS adoption were interviewed. Analysis of interviews revealed three overarching themes that stakeholders considered important to adoption by clinicians and health systems: clinical impact, efficiency and cost. Subthemes included two that were deemed essential to high-fidelity implementation: the development of credentialing policies and robust quality assurance processes. These findings identify potential determinants of system and clinician level adoption that may be leveraged to achieve high-fidelity implementation of POCUS applications that result in improved patient outcomes.
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Schott CK, LoPresti CM, Boyd JS, Core M, Haro EK, Mader MJ, Pascual S, Finley EP, Lucas BP, Colon-Molero A, Restrepo MI, Pugh J, Soni NJ. Retention of Point-of-Care Ultrasound Skills Among Practicing Physicians: Findings of the VA National POCUS Training Program. Am J Med 2021; 134:391-399.e8. [PMID: 32931765 DOI: 10.1016/j.amjmed.2020.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/07/2020] [Accepted: 08/22/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) use continues to increase in many specialties, but lack of POCUS training is a known barrier among practicing physicians. Many physicians are obtaining POCUS training through postgraduate courses, but the impact of these courses on skill retention and frequency of POCUS use post-course is unknown. The purpose of this study was to assess the change in POCUS knowledge, skills, and frequency of use after 6-9 months of participating in a brief training course. METHODS Course participants' POCUS knowledge and hands-on technical skills were tested pre-course using an online, 30-question knowledge test and a directly observed skills test, respectively. The same knowledge and skills tests were repeated immediately post-course and after 6-9 months using remote tele-ultrasound software. Course participants completed a survey on their POCUS use pre-course and after 6-9 months post-course. RESULTS There were 127 providers who completed the POCUS training course from October 2016 to November 2017. Knowledge test scores increased from a median of 60% to 90% immediately post-course followed by a slight decrease to 87% after 8 months post-course. Median skills test scores for 4 common POCUS applications (heart, lung, abdomen, vascular access) increased 36-74 points from pre-course to immediately post-course with a 2-7-point decrease after 8 months. Providers reported more frequent POCUS use post-course, which suggests application of their POCUS knowledge and skills in clinical practice. More frequent use of cardiac POCUS applications was associated with significantly greater retention of cardiac skills at 8 months. CONCLUSIONS Practicing physicians can retain POCUS knowledge and hands-on skills 8 months after participating in a 2.5-day POCUS training course, regardless of frequency of POCUS use post-course.
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Affiliation(s)
- Christopher K Schott
- Department of Critical Care Medicine, Veterans Affairs of Pittsburgh Health Care System, Pittsburgh, Pa; Department of Critical Care Medicine and Emergency Medicine, University of Pittsburgh and University of Pittsburgh Medical Center (UPMC), Pa.
| | - Charles M LoPresti
- Medicine Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Ohio; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jeremy S Boyd
- Department of Emergency Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville; Department of Emergency Medicine, Vanderbilt University, Nashville, Tenn
| | - Megan Core
- Department of Emergency Medicine Service, Orlando Veterans Affairs Medical Center, Fla; Department of Medicine, University of Central Florida College of Medicine, Orlando
| | - Elizabeth K Haro
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Texas
| | - Michael J Mader
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Texas
| | | | - Erin P Finley
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Texas
| | - Brian P Lucas
- Medicine Service, White River Junction VA Medical Center, White River Junction, Vt; Department of Medicine, Dartmouth Geisel School of Medicine, Hanover, NH
| | - Angel Colon-Molero
- VHA Specialty Care Service, Veterans Affairs Central Office (VACO), Washington, DC
| | - Marcos I Restrepo
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Texas
| | - Jacqueline Pugh
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Texas
| | - Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Texas
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Singh MR, Jackson JS, Newberry MA, Riopelle C, Tran VH, PoSaw LL. Barriers to point-of-care ultrasound utilization during cardiac arrest in the emergency department: a regional survey of emergency physicians. Am J Emerg Med 2021; 41:28-34. [PMID: 33383268 DOI: 10.1016/j.ajem.2020.12.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Though point-of-care ultrasound (POCUS) is recognized as a useful diagnostic and prognostic intervention during cardiac arrest (CA), critics advise caution. The purpose of this survey study was to determine the barriers to POCUS during CA in the Emergency Department (ED). METHODS Two survey instruments were distributed to emergency medicine (EM) attending and resident physicians at three academic centers in the South Florida. The surveys assessed demographics, experience, proficiency, attitudes and barriers. Descriptive and inferential statistics along with Item Response Theory Logistic Model and the Friedman Test with Wilcoxon Signed Rank tests were used to profile responses and rank barriers. RESULTS 206 EM physicians were invited to participate in the survey, and 187 (91%) responded. 59% of attending physicians and 47% of resident physicians reported that POCUS is performed in all their cases of CA. 5% of attending physicians and 0% of resident physicians reported never performing POCUS during CA. The top-ranked departmental barrier for attending physicians was "No structured curriculum to educate physicians on POCUS." The top-ranked personal barriers were "I do not feel comfortable with my POCUS skills" and "I do not have sufficient time to dedicate to learning POCUS." The top-ranked barriers for resident physicians were "Time to retrieve and operate the machine" and "Chaotic milieu." CONCLUSIONS While our study demonstrates that most attending and resident physicians utilize POCUS in CA, barriers to high-quality implementation exist. Top attending physician barriers relate to POCUS education, while the top resident physician barriers relate to logistics and the machines. Interventions to overcome these barriers might lead to optimization of POCUS performance during CA in the ED.
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Affiliation(s)
- Mallika R Singh
- University of Miami Miller School of Medicine, Miami, FL, United States of America.
| | - Jennifer S Jackson
- University of Miami Miller School of Medicine, Miami, FL, United States of America; Holy Cross Hospital, Ft. Lauderdale, FL, United States of America.
| | - Mark A Newberry
- Mt. Sinai Medical Center, Miami Beach, FL, United States of America.
| | - Cameron Riopelle
- University of Miami Miller School of Medicine, Miami, FL, United States of America; University of Miami Libraries, University of Miami.
| | - Vu Huy Tran
- Aventura Hospital & Medical Center, Aventura, FL, United States of America.
| | - Leila L PoSaw
- Jackson Memorial Hospital, Miami, FL, United States of America.
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Gutierrez P, Berkowitz T, Shah L, Cohen SG. Taking the Pulse of POCUS: The State of Point-of-Care Ultrasound at a Pediatric Tertiary Care Hospital. POCUS JOURNAL 2021; 6:80-87. [PMID: 36895674 PMCID: PMC9979874 DOI: 10.24908/pocus.v6i2.14781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We aim to quantify and categorize point-of-care ultrasound (POCUS) usage by pediatric practitioners and trainees at our tertiary care center, and assess the degree of interest from pediatric residents, fellows, and program leaders for integrating POCUS into their training. Data was collected via online survey, evaluating the current use of POCUS in clinical decision making, desire for further formal training, and opinions on the importance of POCUS to future clinical practice. In total, 14 program directors/assistant program directors (PD/APDs) representing 10 of 15 training programs, 30 of 95 fellows representing 9 of 15 fellowships, and 32 of 82 residents responded. From PD/APDs, only 2 of the programs reported active use POCUS for clinical decision making, but 13 of the fellows and 9 residents reported doing so. In regard to desire for a formal POCUS program, 30.8% of PD/APDs, 43.8% of fellows without current curricula, and 87.5% of residents were interested in participating in such a program. When considering specialty, some non-acute care-based PD/APDs and fellows at our institution felt that POCUS was important to future practice. Pediatric subspecialty PD/APDs and their fellows had divergent outlooks on the importance of POCUS in future practice. Finally, an overwhelming majority of residents at our institution expressed a desire to learn, and half believing it will be important to future practice. Based on the degree of interest, medicolegal considerations, and trajectory of patient care, pediatric residency and fellowship programs should strongly consider integrating POCUS education into their curricula.
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Affiliation(s)
- Peter Gutierrez
- Emory University School of Medicine Atlanta, GA.,Children's Healthcare of Atlanta Atlanta, GA
| | - Tal Berkowitz
- Emory University School of Medicine Atlanta, GA.,Children's Healthcare of Atlanta Atlanta, GA
| | - Lekha Shah
- Emory University School of Medicine Atlanta, GA.,Children's Healthcare of Atlanta Atlanta, GA
| | - Stephanie G Cohen
- Emory University School of Medicine Atlanta, GA.,Children's Healthcare of Atlanta Atlanta, GA
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