Abstract
Background: A quality assurance system is vital when using point-of-care ultrasound (POCUS) to ensure safe and effective ultrasound use. There are many barriers to implementing a quality assurance system including need for costly software, faculty time, and extra work to log images. Methods: With minimal funding or protected faculty time, we successfully developed an effective remote quality assurance system between residents rotating internationally and faculty in the US. Results: 270 total exams were logged using this system (41 per resident over a 7 week period). Over the course of the implementation period, a significant increase was seen in average image quality (p = 0.030) and percent agreement with reviewer (p = 0.021). No significant increase was seen for percent images with quality rating 5/5 (p = 0.068) or for studies per resident per week (p = 0.30). Discussion/Conclusions: A quality assurance system for remote review and feedback of POCUS exams was successfully developed with limited available funding, using consumer-level software and an educational collaboration. Residents used the system regularly and demonstrated improvement in reviewer-rated image acquisition and interpretation skills. A similar system can be applied for physicians in any geographic area looking to learn POCUS, in partnership with local or international POCUS mentors. We detail a step-by-step approach, challenges encountered, and lessons learned, to help guide others seeking to implement similar programs.
Highlights
The ability of point-of-care ultrasound (POCUS) to provide rapid and accurate bedside assessment of both the heart and lungs allows it to be a powerful tool in the management of patients presenting with dyspnea
There was no formal system for image quality assurance (QA), and since this is such a critical component of a POCUS curriculum and implementation, this was identified as a key area for improvement
Since we studied data collected through this process of performing POCUS exams and QA, we were studying existing data so there was no recruitment of participants and obtaining informed consent was exempted
Summary
The ability of point-of-care ultrasound (POCUS) to provide rapid and accurate bedside assessment of both the heart and lungs allows it to be a powerful tool in the management of patients presenting with dyspnea. While ultrasound equipment is readily available even in remote healthcare settings in Canada, physicians lack effective training opportunities to develop expertise in this potentially life-saving skill. To answer this critical call to action, we have developed the Accelerated Remote Consultation Tele-POCUS in Cardiopulmonary Assessment (ARCTICA) program to innovate POCUS training for today’s physician leaders. Discussion/ Conclusions: A quality assurance system for remote review and feedback of POCUS exams was successfully developed with limited available funding, using consumer-level software and an educational collaboration. Effective implementation of POCUS usage involves image acquisition, interpretation, clinical integration, and ongoing quality assurance (QA) [4,9,10,11,12]. Many educational leaders advocate prioritizing longitudinal and sustainable models for training [4,17,18]
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