Point-of-care ultrasound in rural New Zealand: Safety, quality and impact on patient management.

Abstract

To evaluate the safety, quality and impact of point-of-care ultrasound on patient management when performed by rural generalist doctors. Cross-sectional descriptive study. Six rural small hospitals serving a range of communities in rural New Zealand. All generalist doctors practising ultrasound in the study hospitals. Technical quality, accuracy, impact on diagnostic certainty, patient disposition and overall patient care. Participants correctly interpreted 90% of images and a similar percentage of point-of-care ultrasound findings when compared with the results of formal imaging or the final diagnosis. In total, 87% of scans contributed to the diagnostic process, changing the diagnostic probability. There was a 4% overall reduction in the number of patients needing hospital admission or transfer to an urban base hospital. The overall impact on patient care was positive for 71% of point-of-care ultrasound scans. Three percent of scans had the potential for patient harm. Rural generalists' practise a broad scope of point-of-care ultrasound that, when used as a part of the full clinical assessment, has a positive impact on patient care, improving diagnostic certainty and reducing the need for hospital admission and inter-hospital transfer. There are challenges in learning and maintaining the skills needed to practise a high standard of point-of-care ultrasound in this context. Further consideration needs to be given to the development safe scopes of practice, training, credentialing and quality assurance.