Impact Evaluation of a Clinical Point-of-care Ultrasound Intervention in an Academic Emergency Department.

内容摘要

Point-of-care ultrasound (POCUS) can expedite patient diagnoses and improve procedural safety in emergency department (ED) patients. Nevertheless, clinical POCUS use lags in many ED sites nationwide, with only 40% of community physicians using POCUS according to a study from 2019-2021. We studied the impact of a multifaceted clinical POCUS intervention to address barriers and increase clinical POCUS use. We conducted a prospective cohort study at a single academic hospital that included ED attendings, residents, and advance practice clinicians (APC). A multifaceted four-week intervention for emergency clinicians from December 2023-January 2024 addressed barriers to POCUS use identified on a pre- and post-intervention survey. The intervention included POCUS education during clinical shifts by ultrasound faculty, clinical POCUS workflow demonstration during resident conference/faculty meetings, and QR code reference files on machines for a total of two hours of additional training per clinician. The primary outcome was the number of clinical ED POCUS performed during the 18 months pre-intervention and 12 months post-intervention. Secondary outcomes were POCUS workflow knowledge exam scores and POCUS revenue. We analyzed clinical POCUS numbers from July 2022-December 2024 using an interrupted time series model. Forty-two of 99 emergency clinicians (42.4%) responded to surveys pre-intervention and 28 post-intervention (28.3%). Fifty-six physicians/APCs (56.6%) participated in the in-person POCUS intervention (17 attendings, 34 residents, 5 APCs). The unadjusted number of POCUS exams performed increased from 6,708 pre-intervention (18 months) to 11,600 post-intervention (12 months). After controlling for the underlying secular trend, we saw no effect of the intervention with no significant increase in overall number of POCUS exams performed per 100 ED patients after the intervention (mean level change = -0.81, 95% CI, -2.43 to 0.82; P = .33). Neither was there an increase in the slope of the secular trend post-intervention (difference in slope, β = 0.00, 95% CI, -0.10 to 0.10; P = .98 for post-intervention, β = 0.02, 95% CI, -0.08 to 0.12 for sustainability period). Monthly POCUS revenue increased ~$55,000 in total billed and $10,000 reimbursed (~16% reimbursement). This was the professional component only that was billed by the physician and not the technical component covering equipment and maintenance. Post-intervention mean knowledge scores were 88% correct (standard deviation 12.0) with 16/22 participants (72.7%) passing the assessment (score > 90%). A multifaceted intervention was not shown to improve clinical point-of-care ultrasound use and revenue when accounting for an underlying sustained secular upward trend in number of POCUS exams performed per 100 emergency department patients throughout the study period. Future interventions directed toward low POCUS users and identification of clinical POCUS champions may improve clinical POCUS use.