Point-of-care ultrasonography adoption in Canada: using diffusion theory and the Evaluation Tool for Ultrasound skills Development and Education (ETUDE)

Abstract

Objective: Point-of-care ultrasonography (PoCUS) first appeared in the 1980s in North America, but the extent of the diffusion of its adoption is unknown. We characterized early PoCUS adoption by emergency physicians in Canada and its barriers to use using Rogers' diffusion of innovations theory. Methods: We developed a questionnaire based on a pilot study and literature review to assess past, current, and potential use of PoCUS and potential barriers to adoption. A Dillman technique for electronic surveys was used for dissemination. Using Rogers' diffusion of innovations theory, we developed and validated the Evaluation Tool for Ultrasound skills Development and Education (ETUDE). ETUDE scores allowed categorization of respondents into innovators, early adopters, majority, and nonadopters. Descriptive statistics, correlations, and x 2 statistics were used to analyze the data. Results: The 296 respondents (36.4% of 814 surveyed) had a median age of 40 and were 72.5% male. Adoption scores using ETUDE revealed nonadopters (18.8%), majority (28.7%), early adopters (34.5%), and innovators (18.0%). Respondents endorsed ''always'' using PoCUS currently and in the future for focused assessment with sonography in trauma (FAST) (current 41.8%/future 88.4%), first trimester pregnancy (current 23.3%/future 73.7%), suspected abdominal aortic aneurysm (current 32.7%/future 92.6%), basic cardiac indications (current 30.7%/future 87.5%), and central venous catheterization (current 17.0%/future 80.3%). Several barriers to PoCUS were identified for part-time emergency physicians and those working in inner-city/urban/suburban settings.

Point-of-care ultrasonography in Norwegian out-of-hours primary health care

“…Other studies have also shown this, suggesting that male physicians are more likely to be early adopters of ultrasound [9,17]. Noteworthy, one study found that females felt they required more training compared to males to start using POCUS [18]. Similar examples can be found elsewhere in the adoption of technology [19].…”

Barriers to point-of-care ultrasound use in rural emergency departments

“…With lower patient volume, rural physicians may not have the opportunity to obtain competency in the learned skills or maintain them over time. 20 CEUS and other PoCUS certifying courses, such as EDTU and ECCU, require at least 50 determinate scans in each of the four domains of focused assessment with sonography in trauma (FAST), subxiphoid cardiac view for pericardial effusion, transabdominal scan for abdominal aortic aneurysm, and pelvic scan for confirming intrauterine pregnancy. Physicians must then complete visual, written, and practical exams to achieve independent practitioner (IP) status.…”

Current State of Point-of-care Ultrasound Usage in Canadian Emergency Departments

“…Despite the clear benefits of POCUS usage and rapid expansion of its utility in the ED, Canadian adoption rates and attitudes toward this technology have not been recently assessed. A Canadian census of past, current, and projected POCUS usage, as well as barriers to adoption, was most recently performed by Woo et al in 2007 using the Canadian Association of Emergency Physicians (CAEP) survey distribution database [15]. They found the number of survey respondents who reported “always” using POCUS for the following Canadian Point of Care Ultrasound Society (CPOCUS) core applications was FAST 41.8%, basic cardiac assessment 30.0%, early pregnancy assessment 23.3%, and abdominal aortic aneurysm assessment (AAA) 30.7%.…”