Background: Point of Care Ultrasound (POCUS) has been used to improve diagnostic accuracy and provide earlier and more focused treatment intervention. Although hospital-based clinicians are prime candidates for utilizing this skill, very few regularly integrate POCUS into their clinical practice after completing a training course. This study sought out to identify the facilitators and barriers to utilizing POCUS after training.
Methods: An anonymous survey study was conducted at 11 diverse hospitals within a large integrated health system in the Northeast. Survey links (via REDCap) were emailed to healthcare professionals (e.g., hospitalists, trainees, and advanced practitioners) who completed a 2-day health system POCUS course over 4 years. Survey questions (e.g., dichotomous, and 5-point Likert scale) included: reasons for attending the course, course satisfaction, frequency of and confidence in POCUS use, available resources for ongoing POCUS use (e.g., longitudinal education, POCUS champions, and mentored scanning), as well as perceived barriers and facilitators for adoption and integration of POCUS into clinical practice. Statistical analyses (via SAS 3.8) consisted of: Pearson’s correlation (ordinal responses) and Mann-Whitney Wilcoxon test (exploring if the distribution of ordinal variables differed by classification variables).
Results: Of the 217 eligible health care professionals, 70 completed the survey (rate of 32%). The average age of respondents was 38, most identified as female (53%, n=39), and most reported >75% of their time was dedicated to clinical practice (77%, n=57). Nearly 90% (n=65) were hospital-based providers. All (100%) participants reported that POCUS was a diagnostic modality that could be used by clinicians to improve and expedite care and 94% (n=66) agreed or strongly agreed that every clinician should learn POCUS. Regarding POCUS training, 60% (n=42) were very or extremely satisfied with the 2-day POCUS course and over half of participants agreed or strongly agreed that they felt confident in image acquisition (54%, n=38), image interpretation (53%, n=37), and clinical integration (57%, n=40). Further, 14% (n=10) reported additional POCUS training. Yet, nearly half reported never or rarely using diagnostic lung (48.5%, n=34) or cardiac (47%, n=33) POCUS. The leading perceived facilitators to adoption of POCUS into practice included: adequate training (30%, n=21) and longitudinal education (i.e., didactics, mentored scanning; 28.5%, n=20). The top perceived barriers to using POCUS that respondents agreed or strongly agreed upon were time constraints of both the learner (71%, n=50) and educator (68.5%, n=48).POCUS use in clinical practice was associated with the primary reason for seeking POCUS training. Compared to professional development and required or recommended training, clinical skills improvement and trainee teaching were associated with increased use of diagnostic lung (p=0.004 and p=0.004, respectively) and cardiac (p=0.003 and p=0.005, respectively) POCUS. Additionally, there was a significant correlation between cumulative days of POCUS training and confidence in image acquisition (p=0.006), image interpretation (p=0.01), and clinical integration (p=0.007).
Conclusions: Though the survey revealed that POCUS use in clinical care was highly regarded, there was a disconnect with its use in clinical practice. Future studies should evaluate the role of longitudinal training as a facilitator for POCUS use.