Background: Point of Care Ultrasound (POCUS) is a goal-directed, bedside ultrasound examination performed by a healthcare provider to answer a specific diagnostic question or guide performance of an invasive procedure at the bedside. More hospitalists have begun to use POCUS, but little is known about current POCUS usage by hospitalists. We conducted a national survey to better understand current POCUS usage patterns and training needs amongst hospitalists in the Veterans Affairs (VA) healthcare system.
Methods: In collaboration with the VA Healthcare Analysis and Information Group, a professional surveying group with expertise in survey methods, we conducted a cross-sectional study of all VA hospitals across the United States to assess the current POCUS usage, barriers, and desire for training. A 47-question survey was prepared by a multidisciplinary POCUS Technical Advisory Group and sent to chiefs of staff (COS) and service chiefs from all VA hospitals from April to July 2016. Data were analyzed using descriptive and comparative statistical analysis.
Results: Survey responses were received from all COSs (n=115), and 28 confirmed hospital medicine section chiefs. The majority of hospitalist groups (82%) reported using POCUS for at least 1 diagnostic or procedural application. POCUS was most commonly used for procedural applications (96%), followed by abdominal (70%), pulmonary (61%), and cardiac (52%) diagnostic applications. Significantly more hospitalist groups that currently use POCUS desired more training compared to hospitalist groups that do not use POCUS (81% vs. 28%; p <0.00001), more so for diagnostic applications (89% vs. 28%; p<0.00001) than procedural applications (71% vs. 28%; p<0.00001). For central line placement, 26% of hospitalist groups do not use ultrasound guidance with approximately half of them not desiring training. All current user groups (100%) desire more training in pericardial effusion, left ventricular systolic function, pulmonary edema, pneumonia, deep venous thrombosis, joint effusion, cellulitis, and abscess (with drainage). The diagnostic and procedural applications with the greatest desire for training were paracentesis, pleural effusion, thoracentesis, and peritoneal free fluid.
Conclusions: Most hospital medicine groups at VA hospitals currently use POCUS for diagnostic or procedural applications. The desire for additional POCUS training is strongly associated with current POCUS usage. The findings of this study can guide future development of POCUS educational curricula for both VA and non-VA hospitalist groups.