Best Practices for Point of Care Ultrasound: An Interdisciplinary Expert Consensus

Despite the growing use of point of care ultrasound (POCUS) in contemporary medical practice and the existence of clinical guidelines addressing its specific applications, there remains a lack of standardization and agreement on optimal practices for several areas of POCUS use. The Society of Point of Care Ultrasound (SPOCUS) formed a working group in 2022 to establish a set of recommended best practices for POCUS, applicable to clinicians regardless of their training, specialty, resource setting, or scope of practice. Using a three-round modified Delphi process, a multi-disciplinary panel of 22 POCUS experts based in the United States reached consensus on 57 statements in domains including: (1) The definition and clinical role of POCUS; (2) Training pathways; (3) Credentialing; (4) Cleaning and maintenance of POCUS devices; (5) Consent and education; (6) Security, storage, and sharing of POCUS studies; (7) Uploading, archiving, and reviewing POCUS studies; and (8) Documenting POCUS studies. The consensus statements are provided here. While not intended to establish a standard of care or supersede more targeted guidelines, this document may serve as a useful baseline to guide clinicians, leaders, and systems considering initiation or enhancement of POCUS programs.

Point-of-care ultrasound assessment of the abdominal aorta by physician assistant students: a pilot study

OBJECTIVE

Point-of-care ultrasound (POCUS) decreases time to diagnosis and improves mortality of those diagnosed with abdominal aortic aneurysms and dissections. While medical students have demonstrated an ability to obtain adequate POCUS images of the abdominal aorta (AA), physician assistant (PA) student studies are lacking. This pilot study aims to evaluate the ability of PA students to acquire AA POCUS images.

METHODS

PA students, instructors, and models voluntarily participated. Student participants received online material to review several weeks before the study. During the study, students performed 4 precepted practice scans of the AA, and their fifth scan was recorded for review by three ultrasound fellowship trained Emergency Medicine physicians. Images were graded on proper identification and measurement of the AA, as well as interpretability of images.

RESULTS

A total of 20 PA students participated. Ninety-five percent were able to obtain interpretable transverse images of the distal aorta and longitudinal views of the aorta, and 65% were able to obtain interpretable transverse images of the proximal and mid aorta.

CONCLUSIONS

In the most rigorous evaluation of student-obtained AA POCUS images to date, we found that PA students were able to obtain adequate AA images. PA students were able to image the distal and longitudinal aorta in the transverse plane where the majority of AAAs are found to a very high degree. Results demonstrate PA students' ability to learn POCUS and encourage PA education to take steps to incorporate POCUS education and development of competency standards for PA graduates.

Issues arising when crossing a border to give birth: an exploratory study on the French-Belgian border

BACKGROUND

Anecdotal evidence suggests that many organised initiatives for cross-border collaboration in healthcare in border regions originate from the need for women to give birth close to home. Despite this, there is remarkably little research on these practices and the specific modes of collaboration between providers and experiences and needs of these women. In this paper we describe the experiences of French women who choose to give birth in Belgium.

STUDY DESIGN

We conducted semi-structured interviews with 14 key informants and captured the experiences of 14 French mothers using a 40-item questionnaire.

RESULTS

The chief motivations for French mothers to cross the border to deliver a baby in Belgium were geographical proximity as well as perceived better quality of care. Several procedural differences between France and Belgium were highlighted as possibly affecting the quality of follow-up care, including the absence, in some cases, of a contact person in France, and communication problems between providers.

CONCLUSION

There is a tension between the testimony of patients who are clearly satisfied and evidence of problems in communication and weak collaboration between providers on either side of this cross border collaboration. This paradox requires more research efforts to generate clear evidence of the added value of these cross-border collaborations for patients.

Assessment of patients' health status in family medicine

General Practitioners feel increasing pressure from Public Health authorities to evaluate their work but generally accept outcome indices such as morbidity and mortality are too far away from GP practices to allow direct evaluation conclusions. A simple instrument is needed to assess the evolution in the health status of the populations the GP serves. To design such an instrument we developed a short, inexpensive questionnaire, to be filled in by the GP, that covers as many fields of health care as possible and reflects as closely as possible the specific approach in family practice. To construct this instrument five Guttman scales were first developed that refer to the five frameworks of though that a general practitioner uses, and submitted them to a process of validation. A composite index (SAMI) was mathematically derived from these five scales; it proved to be a valid instrument for measuring health status. To field test the SAMI index, a prospective cohort study was carried out in two subpopulations, Belgians and migrants, consulting seven GP practices. The evolution of four reasons for encounter (low back pain, pregnancy, diabetes and epigastralgia) were monitored by means of the five scales and the SAMI index. The evaluative conclusion that, despite special efforts of the GPs, their approach to migrants has to be reconsidered, is drawn. Above all the field test has shown that the five measurement scales and the global SAMI index are valid instruments, of easy use in general practice, that allow to assess the global health status of patient populations and give opportunities for evaluation of PHC services.