QUERI – Quality Enhancement Research Initiative

Evaluation of Implementation of a National Point-of-care Ultrasound Training Program

San Antonio, TX

Overview:

Point-of-care ultrasound (POCUS) has been shown to reduce procedure-related complications from invasive bedside procedures and to reduce ancillary diagnostic testing, which ultimately decreases patients’ exposure to ionizing radiation from CT scans, as well as lowering healthcare costs. Despite its potential advantages, POCUS has not been well adopted into healthcare, an important barrier being the limited number of providers trained in its use.  VA's Simulation Learning, Education and Research Network (SimLEARN) and Specialty Care Centers of Innovation (SCCOI) have launched a collaborative initiative to develop a national POCUS training program to teach frontline VA providers basic diagnostic and procedural applications of POCUS. Implementation of POCUS in the VA healthcare system can improve timeliness of services, especially bedside procedures, while focusing resources more efficiently and modernizing the delivery of care to Veterans. The aims of our partnered evaluation are to:

• Evaluate provider skill acquisition and retention, and the frequency of POCUS use after participation in a POCUS training course;
• Determine the effect of VA’s POCUS training course and implementation facilitation on facility-level frequency of POCUS use;
• Determine provider- and facility-level barriers and facilitators to POCUS use in the VA system; and
• Develop a POCUS champions course to facilitate local implementation by addressing facility-level barriers.

Findings and Anticipated Impacts

• During fiscal years 2017 and 2018, 209 VA providers from 38 VA facilities participated in 18 immersive, hands-on POCUS training courses at the VA SimLEARN National Simulation Center in Orlando, Florida. Courses are ongoing in fiscal year 2019.
• In each course, participants’ POCUS knowledge and hands-on skills were assessed pre-course (day 0), immediately post-course (day 3), and remotely post-course (6-9 months).
  • The knowledge test scores improved from a mean of 62% pre-course to 90% immediately post-course, and then declined slightly to 83% after 6-9 months. Retention of POCUS knowledge at 6-9 months was directly proportional to the frequency of POCUS use post-course: no use (-11%); low use (-6%); frequent use (-4%).
• Similarly, the participants’ mean skills test scores pre-course, imme­diately post-course, and remotely post-course showed a steep improvement followed by a slight decline: lung (17% vs. 77% vs. 72%), cardiac (14% vs. 66% vs. 61%), abdomen (21% vs. 80% vs. 71%), and peripheral IV insertion (25% vs. 76% vs. 71%).
• Baseline barriers to POCUS implementation reported by chiefs of staff at facilities not currently using POCUS were: lack of trained providers (71%), lack of ultrasound equipment (63%), and lack of a clinician champion (29%).
  • POCUS course participants reported the top three barriers to be: lack of being trained in POCUS (55%), cost and difficulty of finding a POCUS training course (37%), and lack of ultrasound equipment availability (34%).
• Course evaluations have been in the excellent range with nearly all participants “strongly agreeing” (91%) or “agreeing” (9%) to recommend the VA POCUS training course to others.

Findings from this QUERI project will guide ongoing efforts of operational partners—VHA Specialty Care Centers of Innovation and the Simulation Learning and Research Network—to establish and grow the national POCUS training program. Additionally, this project’s findings can guide development of facilitated implementation strategies for POCUS use at both VA and non-VA hospitals throughout the United States.

Principal Investigator: Nilam J. Soni, MD, MS; contact at Nilam.Soni@va.gov or Sonin@uthscsa.edu .

Operational Partners:

• VHA Simulation, Learning, Education, and Research Network (SimLEARN)
• VHA Specialty Care Centers of Innovation