Abstract
There is growing interest from multiple specialties, including internal medicine, to incorporate diagnostic point of care ultrasound (POCUS) into standard clinical care. However, few internists currently use POCUS. The objective of this study was to understand the current determinants of POCUS adoption at both the health system and clinician level at a U.S. academic medical center from the perspective of multi-level stakeholders. We performed semi-structured interviews of multi-level stakeholders including hospitalists, subspecialists, and hospital leaders at an academic medical center in the U.S. Questions regarding the determinants of POCUS adoption were asked of study participants. Using the framework method, team-based analysis of interview transcripts were guided by the contextual domains of the Practical Robust Implementation and Sustainability Model (PRISM). Thirty-one stakeholders with diverse roles in POCUS adoption were interviewed. Analysis of interviews revealed three overarching themes that stakeholders considered important to adoption by clinicians and health systems: clinical impact, efficiency and cost. Subthemes included two that were deemed essential to high-fidelity implementation: the development of credentialing policies and robust quality assurance processes. These findings identify potential determinants of system and clinician level adoption that may be leveraged to achieve high-fidelity implementation of POCUS applications that result in improved patient outcomes.
Highlights
Point of care ultrasound (POCUS) is ultrasound imaging that is acquired and interpreted by a clinician at the bedside
Given the multi-level institutional and external factors that affect the adoption of point of care ultrasound (POCUS) by clinicians and health systems, we selected the Pragmatic Robust Implementation and Sustainability Model (PRISM) to frame our investigation
Recruited clinicians had a broad spectrum of POCUS experience ranging from novice to experts who routinely use POCUS for diagnosis of multiple disease processes including pneumothorax, pneumonia, pleural effusion, and decompensated heart failure
Summary
Point of care ultrasound (POCUS) is ultrasound imaging that is acquired and interpreted by a clinician at the bedside. Driven by growing clinical evidence [1,2,3], there is increasing interest in the integration of POCUS use into routine clinical care by multiple specialties. Though emergency medicine [4] and critical care [5,6] were the first specialties to integrate POCUS into their training standards, multiple other medical and surgical specialties are following their lead, including internal and hospital medicine whose professional societies officially endorse diagnostic POCUS use [7,8]. Prior studies indicate the cost of equipment and training opportunities were the most commonly reported barriers to adoption by clinicians [10]. While recent surveys have published determinants of clinician adoption of POCUS [11], barriers likely vary significantly by local setting. Implementation efforts must begin with assessing current determinants experienced by local clinicians as implementation will certainly fail without their buy-in
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
