Introduction: Point of care ultrasound (POCUS) has been used in diagnostic and therapeutic procedures to help minimize procedure related morbidity and mortality. There has been a shift to using POCUS to help improve clinical assessment of patients as part of the physical exam. Our project focused on identifying barriers to using POCUS and implementing guidance to improve use.
Methods: We surveyed the Internal Medicine and Med-Peds residents on their POCUS use frequency, the purposes for use, and barriers to use. The pre-survey revealed that most residents used POCUS 1-2 times per week, and most used it for procedures and cardiac/IVC exam. Additionally there were 3 major areas of concern which were chosen for intervention - inability to find the equipment, uncertainty in how to interpret the results and the exam being time consuming. For the intervention, the project focused on making a guidebook which will help with interpretation of results and subsequently shorten the time spent on doing exams. The guidebook consisted of the four main areas – cardiac, lung, abdomen and IVC [Inferior Vena Cava] evaluation. This is an extension on existing presentations and lectures that are part of the curriculum. It was sent out to the residents through Microsoft teams, email and a QR code posted on the ultrasound machines. Primary outcome was the likelihood of increased use of POCUS as part of the physical exam.
Results: We sent a post-survey two weeks after the guidebook was distributed. It revealed that more than 60% of respondents are more likely to use ultrasound with the added guidance while 35% of residents did not see the guidance. Further changes to implementation will be made including printed versions in the workrooms and regular reminders. The next cycle will also include a version of the focused abdominal ultrasound for trauma [FAST] exam as the post survey suggested that over 90% of residents know about the exam but would benefit from further guidance on it.
Conclusions: POCUS is an important adjunct tool aiding in diagnosis and management of critically ill patients. We showed that simple guidance can help improve use within the medicine and medicine-pediatrics residents.
