Though the use of point of care ultrasound (POCUS) has increased over the last decade, hospitalists may still find it difficult to gain formal hospital credentialing for POCUS. National organizations have not yet published recommended guidelines for POCUS credentialing in hospital medicine (HM)
We established a protocol for hospitalists at a large tertiary care medical center that details the scope of HM ultrasound, requirements for credentialing, and a quality assurance (QA) program.
Purpose:
To develop a point of care ultrasound credentialing policy and procedure as a model for other HM departments to use as an aid for producing a viable credentialing program in their own institution.
Description:
An interdisciplinary approach was created by our institution to address training, competency, and ongoing QA concerns due to the increasing popularity of POCUS usage. We developed a hospital wide POCUS committee with members from emergency medicine, radiology, cardiology, obstetrics and gynecology, critical care and HM with a charter to standardize the level of care with POCUS across departments. After extensive review of the literature, baseline training requirements were established. A variety of assessments were used to ensure a provider has developed competence (portfolio development, knowledge based examination, skills based assessment, ongoing quality assurance process). The POCUS committee identified which exams could be performed at bedside for credentialed providers, delineated imaging requirements for each exam, and set up the information technology infrastructure to support ordering and reporting through electronic health records (EHR).
Step 1: Pathway to POCUS Credentialing in HM – Complete Minimal Formal Requirements
Residency Based Pathway: Have completed residency training in an ACGME-approved residency program that included formal hands on ultrasound instruction and portfolio development.
OR
Practice Based Pathway: Completed twenty (20) hours of Point of Care Ultrasound CME with at least six (6) hours of hands on ultrasound scanning and has completed five (5) proctored limited cardiac ultrasound cases (as part of CME).
The majority of HM providers had little formal training in POCUS so a training program needed to be developed that was adapted off of CHEST’s critical care ultrasonography program that met the above requirements.
Step 2: Pathway to POCUS Credentialing in HM – Complete Portfolio and Final Assessments (Knowledge and Skills-Based)
After completion of the minimal formal training, applicants need to provide documentation of a set number of cases based on literature review and consensus from the hospital wide POCUS committee. A final knowledge exam and skills were also provided. Providers who met these requirements are able to apply for POCUS credentialing in HM.
QA is maintained through the interdisciplinary POCUS committee and is described in Figure 1. Since 2015, 50 providers have taken introductory courses and started on this credentialing pathway. 4 have been credentialed as of December 2016, with an additional 15 expected in 2017.
Conclusions:
It is important that POCUS users create an infrastructure that maximizes quality of care while minimizing patient risk. This novel protocol is intended as a guide for hospitalists as they work with their own credentialing committees and will require modification for each institution; however, the overall process described here should assist in the establishment of POCUS at various institutions.