Proactive management of point-of-care ultrasound (POCUS) equipment is critical for operations in the modern emergency department (ED). While abundant literature exists surrounding the use of POCUS in the ED, formal recommendations for machine upgrade, maintenance, and renewal have not yet been described. This pilot study proposes a novel method for data-driven, routine assessment of ED POCUS machines to guide upgrade and replacement decisions. In our tertiary academic hospital ED, we evaluated the clinical effectiveness of nine ultrasound devices of four different models in five patient care areas over one year. The ULTrA scoring system assigned up to 5 points in each of the four categories: Utilization rate (U) (number of scans performed per device); Likeability (L), graded by eight POCUS faculty members and ultrasound fellows; machine Trustworthiness (Tr), based on retroactive review of down-time required for troubleshooting or repair; and device Age (A). The Score is shown in Table 1. During the study period, 67,942 scans were completed. Utilization for a single machine ranged from 43% of all scans to <1% of all scans. Likability scores ranged from 3-5 (median 4). Trustworthiness ranged from 3-5 (median 4). Age ranged from 1-9 years (median 6 years). ULTrA scores ranged from 12 to 19 (median 14), with one model (A-i) earning the three highest scores (19, 18, 17) and another model (B-i) earning the three lowest scores (12, 12, 12). Regardless of machine make/model, likability, trustworthiness, and age, utilization was highest for machines primarily located in high-acuity areas of the adult ED when compared with low-acuity areas. “Acute” machines contributed to 52% of all scans, while “Pediatric” machines contributing to only 1%. In this study, we describe the ULTrA model for data-driven, routine assessment of ultrasound devices to forecast need for near-future machine upgrades or replacement. Our findings propose that the ULTrA scoring model as a mostly objective score to identify underperforming devices. This composite score may be used instead of individual proxies for clinical effectiveness, such as age, utilization, or provider preference on their own.