Diku Mandavia

Point-of-care ultrasound (POCUS) oversight and safety

January 17, 2020
By Diku Mandavia

The stethoscope, the blood pressure monitor, and point-of-care ultrasound (POCUS). They are all powerful tools that clinicians have come to rely on to augment diagnostics, choose treatments, and make important decisions about referral. Moreover, each is portable and easy to use in a variety of settings and situations.

However, POCUS stands apart from the others when it comes to the sheer sophistication of the technology as well as the skill required to perform exams and interpret the images it delivers.

Yet, POCUS has enjoyed rapid adoption in hospitals and private practices. In fact, one recent study estimates that on average a general practitioner’s office performs anywhere from 131 to 601 ultrasound examinations annually.

No doubt, POCUS is advancing care in hospitals at the bedside, in the ER, OR, and the ICU, and also out in the field in remote areas. POCUS is a valuable and life-saving tool that also reduces cost which is very important in today’s value based care world.

Despite this, in a recent special report, the ECRI Institute named POCUS among its Top 10 Health Technology Hazards for 2020. The Institute claims, “a lack of oversight regarding the use of point-of-care ultrasound—including when to use it and how to use it—may place patients at risk and facilities in jeopardy.”

The Institute cites a host of safety concerns. These include POCUS not being used when warranted, misdiagnoses, inappropriate use of the modality, and overreliance on POCUS when a more comprehensive exam by an imaging specialist is indicated.

As with any medical technology, safety must come first and POCUS is no exception. When rapid adoption—and the training that should go with it—outpaces safeguarding patients, it poses a significant problem for the healthcare community.

The ECRI Institute’s report overlooks a key fact, however. It fails to mention that presently there are numerous POCUS vendors selling a wide range of POCUS devices—and among them, both manufacturer commitment and product quality vary a great deal. Simply put, choosing the right partner vendor for an organization’s POCUS needs is the first step toward ensuring patient safety.

Apples and oranges; need for training
Not all POCUS technologies are created equally. In its genuine attempt to bring transparency to the safety issue, the ECRI Institute has lumped all POCUS tools together. However, the product pool is so vast and diverse it’s like comparing apples and oranges.

Over the past few years there have been a number of POCUS devices brought to market that are far lower in cost than traditional POCUS technologies. While many of these tiny, inexpensive devices are now available, the technology may be inferior. For example, lack of proper testing, poor quality control, cheap hardware or faulty software can all lead to adverse affects when these tools are used on patients.

In short, many of the safety issues that the Institute refers to in its report can be traced directly to the easy access to these extremely low-cost POCUS devices.

Moreover, there is a real need for training. While many hospitals and outpatient facilities understand POCUS and use it safely and effectively, there is some data that suggests more needs to be done.

Many of the most common specialties that utilize POCUS regularly do an extremely good job at mandatory training in residency programs. These specialties include emergency medicine, anesthesiology, critical care and some musculoskeletal based specialties . In these programs residents learn not only how to use the technology but also what criteria to use in order to choose POCUS versus another diagnostic tool as well as proper documentation of procedures.

However, there are other clinicians such as primary care doctors and physician assistants who may not have credentialing criteria and guidelines while in training programs.

Clearly, there is a need for residency programs and health systems to make POCUS education a top priority. That said, healthcare providers should not overlook a valuable partner: POCUS manufacturers can also serve as a key resource for training and much more.

Partnering with accountable vendors
The ECRI Institute’s report raises several legitimate concerns. Let’s examine some of the specifics, and explore how an organization’s POCUS vendor can be an asset when it comes to establishing oversight of POCUS with best practices, policies and procedures.

Training and education
The Institute cites a lack of training and education. Providers should consider all of their options when it comes to adequate training and educational support.

Reputable POCUS vendors will offer training on their equipment, hands-on demonstrations, and troubleshooting of product issues. The best vendors will also stay in touch with providers and be sure to re-train anytime a new feature or software upgrade becomes available on their equipment.

In addition, top notch manufacturers offer online tools that allow users to learn and study—whenever and wherever is convenient for them.

Users log on and learn at the speed that works best for them to gain the confidence required to use POCUS in everyday practice while also branching out and becoming proficient in a variety of applications.

Online resources vary, but the best tools let users quickly search for specific POCUS applications including case studies, webinars, clinical images, videos and more—across a wide array of specialties. Many even include courses that allow users to rate their base knowledge and track progress with built-in evaluation benchmarks.

Finally, providers should look for vendors who collaborate with clinicians and professional associations. For example, POCUS vendors who host workshops or contribute their equipment for training sessions at major meetings such as ACEP and CHEST demonstrate strong interest in the training and education of its end users.

Simply stated, vendors need to be accountable. They cannot just manufacture a great product, they must contribute by providing comprehensive support to the healthcare providers they serve.

IT and credentialing support
The ECRI Institute’s report also notes lack of data and image archiving as a concern. Organizations should look for a POCUS vendor that can provide IT support, as this is a valuable asset.

Select vendors offer solutions that can help providers archive images and can securely centralize and standardize ultrasound exam data. With appropriate IT support, errors are averted, patient data is secure, and nothing is left to chance.

The ECRI Institute’s report discusses the need for better user credentialing. Here again vendors can have a positive impact by offering flexible credentialing tools.

Partner with a POCUS vendor that enforces and streamlines the credentialing process. Does your vendor offer a workflow solution that gives providers control over their POCUS ultrasound education and credentialing? For example, you may be able to run multiple programs simultaneously, and get up-to-date progress reports to monitor student or user development. Designing your own credentialing programs helps meet national and local standards and requirements, and you don’t need to do it all on your own.

In addition, some solutions help organizations achieve higher security confidence through multi-factor login and Active Directory authentication. They may be designed to permit the granting or denying of access based on specialty, department and user profile. Some can even allow users to gain access from any network-connected device and export data to other media—all while maintaining HIPAA compliance.

Generating reports and communicating results
The ECRI Institute cites exam documentation as another are of concern. Once again, key manufacturers will provide workflow management tools that can take some of the challenges out of the reporting and communication process.

Some POCUS solutions provide the ability to create consistent clinical documentation to minimize billing errors, enforce compliance, and make POCUS reporting faster and easier. Configuring worksheets to meet specific department processes drives workflow and reporting standardization, so that clinicians can concentrate on what they do best: Caring for patients.

Making safety the focus
While the ECRI Institute’s report raises some valid concerns about POCUS, it is important for providers to understand that all POCUS technologies are not created equally. In fact, they vary widely in terms of quality and vendor support.

As a non-invasive technology, POCUS is traditionally a safe, cost-effective, powerful tool for diagnosis and for guiding interventional procedures in many clinical environments.

That said, providers must establish POCUS policies and procedures that address institution-wide concerns including user training and credentialing, exam documentation, and data archiving. When it comes to any medical technology, healthcare providers must be vigilant about patient safety and manufacturers should be their biggest supporters.

About the author: Dr. Diku Mandavia, FACEP, FRCPC, is the senior vice president and chief medical officer of Fujifilm SonoSite, Inc. and Fujifilm Medical Systems U.S.A., Inc.