Multi-Level Stakeholder Perspectives on Determinants of Point of Care Ultrasound Implementation in a US Academic Medical Center

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.

Using Iterative RE-AIM to enhance hospitalist adoption of lung ultrasound in the management of patients with COVID-19: an implementation pilot study

“…Transcripts were entered and coded in Dedoose 9.0.17 (SocioCultural Research Consultants LLC, Los Angeles, CA), for data management. The coding process and results of the interview data discussing the general determinants of LUS and not those specific to COVID have been previously described [25].…”

“…Concurrent qualitative data were collected, through interviews with DHM faculty, to understand facilitators and barriers to adoption. Methods used to acquire these qualitative data have been described previously [25].…”

“…In addition, the research team interviewed 12 hospitalists at different stages of LUS training and adoption representing the full range of use from no experience to regular independent use. The interview guide questions were designed to better understand the determinants of LUS implementation and have been published previously [25]. Emerging themes from these data sources were discussed at the twice monthly project meetings as they became available and influenced implementation strategy selection.…”

“…Between September 30th and December 22nd, 2020, the study team conducted a total of 12 interviews with hospitalists, three of whom had already integrated LUS into their management of patients with and without COVID-19 and nine of whom had not yet adopted LUS. Demographics of interviewees and methods used to understand results of general barriers to adoption of LUS captured in these interviews have been described in prior work [25].…”

Implementation Science: Bridging the Gap between Point-of-Care Diagnostics Research and Practice

“…In addition to ensuring accessibility of new POC diagnostics to those who need it, acceptance by stakeholders is key to enabling uptake and appropriate usage of available diagnostics. Thirty-one stakeholders involved in adoption of POC ultrasound (POCUS) implementation in a US academic medical centre were interviewed to determine their perspective on this diagnostic intervention [ 8 ]. The Practical Robust Implementation and Sustainability Model (PRISM) was employed to guide framework analysis for the data collected from interviews with stakeholders.…”