Success of Implementation of a System-Wide Point of Care Ultrasound (POCUS) Training and Privileging Program for Emergency Physicians

Abstract

Objectives Point-of-care ultrasound (POCUS) is widely used in the emergency department (ED). Not all practicing emergency physicians (EPs) received POCUS training during residency, leaving a training gap that is reflected in POCUS privileging. The purpose of this study was to evaluate the success of meeting privileging criteria, as well as associated factors, following implementation of a basic POCUS training and privileging program within a large Department of Emergency Medicine. Methods We implemented a POCUS training and privileging program, based on national guidelines, for faculty physicians who worked at one of the following EDs staffed by the same Department of Emergency Medicine: a pediatric tertiary site, 2 tertiary academic sites, and 7 community sites. POCUS exams included aorta, cardiac, first-trimester obstetrics, and extended focused assessment with sonography in trauma. Pediatric emergency medicine faculty were taught soft tissue and thoracic ultrasound instead of aorta and obstetrics. Completion of the program required 16 hours of didactics, ≥25 quality assured ultrasound examinations by exam type and passing a series of knowledge-based exams. Descriptive statistics were calculated. Associations between physician characteristics and successfully becoming privileged in POCUS were modeled using Firth’s logistic regression. Results 176 faculty physicians were eligible. 145 (82.4%) achieved basic POCUS privileging during the study period. Different pathways were used including: 86 (48.9%) practice-based, 9 (5.1%) fellowship-based, and 82 (46.9%) residency-based. POCUS privileging was lower for those working in a community versus academic setting (OR 0.3, CI 0.1-0.9). A greater number of scans completed prior to the privileging program was associated with greater success. Conclusion Implementation of a POCUS training and privileging program can be successful in a large Department of Emergency Medicine that staffs hospitals in a large-scale healthcare system comprised of both academic and community sites. Faculty physicians with at least some prior exposure to POCUS were more successful.