Utilisation and barriers of PoCUS in a rural emergency department - A quality improvement project.

Abstract

Point-of-care ultrasound (PoCUS) has been recognised as a tool that leads to more definitive diagnoses and enhances clinical decision-making in rural emergency departments (EDs) where diagnostic imaging is limited. We aimed to determine the current utilisation, barriers and solutions to using PoCUS in this rural Saskatchewan ED. Physicians working in the ED participated in a semi-structured interview. An online survey, administered via SurveyMonkey post-interview to provide further context, was used to support qualitative approaches. Interviews were recorded, transcribed and then analysed using inductive interpretation. Seven physicians completed the quantitative survey with a response rate of 70%. Ten physicians were interviewed with a response rate of 100%. Themes identified were that physicians in this community's ED perceived their skill level as determining whether a scan was diagnostic or not, rather than the specific PoCUS application itself. In addition, they performed scans primarily for the purpose of triage. Inadequate training, Core IP certification certification requirement and intradepartmental logistics were barriers to PoCUS utilisation. This study showed that ED physicians in this community perceived PoCUS as a clinical adjunct and as a tool to triage patients for further imaging. Results highlight the need to have accessible training for rural physicians to increase PoCUS utilisation, awareness of current Saskatchewan PoCUS guidelines and education on diagnostic applications of PoCUS. Increased use of PoCUS for specific scans could decrease the need for formal imaging and the associated healthcare system resources.