Start spreading the news: a deliberate approach to POCUS program development and implementation

Abstract

While there is an expanding body of literature on Point-of-Care Ultrasound (POCUS) pedagogy, administrative elements that are necessary for the widespread adoption of POCUS in the clinical environment have received little attention. In this short communication, we seek to address this gap by sharing our institutional experience with POCUS program development and implementation. The five pillars of our program, selected to tackle local barriers to POCUS uptake, are education, workflow, patient safety, research, and sustainability. Our program logic model outlines the inputs, activities, and outputs of our program. Finally, key indicators for the monitoring of program implementation efforts are presented. Though designed for our local context, this approach may readily be adapted toward other clinical environments. We encourage others leading the integration of POCUS at their centers to adopt this approach not only to achieve sustainable change but also to ensure that quality safeguards are in place.

A Clinician’s Guide to the Implementation of Point-of-Care Ultrasound (POCUS) in the Outpatient Practice

“…To ensure program success and identify opportunities for future improvement the program should be objectively and formally evaluated at regular intervals. 23 Planning for this evaluation before implementing a POCUS program is recommended such that it is seamlessly incorporated into the program and can go forward more smoothly. The method of evaluation is ideally simple and directly answers whether the program is successfully addressing the identified problem.…”

“…Best practices in POCUS use include capabilities for archiving images in the electronic health record, regardless of intent to bill, for the sake of quality of care. 23 , 46 , 47 Saved images should include sufficient labeling to include organ/tissue/body region imaged if not obvious and laterality when appropriate in addition to patient identifiers. Whenever possible, ongoing competence should be assessed through periodic image review by POCUS experts, which can be incorporated into credentialling/recredentialling processes.…”

“…Time must be set aside and financially supported to complete these tasks. 23 It is recommended that analysis be conducted of the estimated time required for this purpose and that this be incorporated in any plan or proposal. POCUS leaders are encouraged to benchmark this need against other departments in their institution or outside institutions with a program of similar size and scope.…”

“…Though the approach to POCUS integration could be imagined through multiple frameworks, we will share our thoughts on an approach that we found to be effective. 19 - 28 The basic steps include defining the problem, identifying stakeholders, assessing needs, evaluation planning, securing organizational support, and sustained engagement. Figure 1 suggests an action item checklist for POCUS program developers, and figure 2 provides one potential example of how a program might evolve over time.…”