Sonographer Educator in the Emergency Department to Prevent POCUS Skills Attrition: A Novel Education Intervention

Point-of-care ultrasound (POCUS) is a pivotal diagnostic tool for emergent conditions, yet the variable proficiency of emergency physicians (EPs) poses challenges. Inadequate skills may lead to care delays and suboptimal patient evaluation. This manuscript explores an innovative educational intervention deploying a Registered Diagnostic Medical Sonographer (RDMS) credentialed sonographer educator (SE) in a large academic Emergency Department (ED). We sought to evaluate the feasibility of using a SE to address POCUS skills deficiencies and attrition.

The study involved 26 EPs voluntarily participating in hands-on training with the SE between July 2021-June 2022. The educational sessions addressed machine operation, image acquisition, image interpretation, and electronic medical record documentation of POCUS results. Subjects who consented completed a survey on their comfort level with POCUS before and after the intervention.  Results: Survey data indicated increased comfort and competence among participants with basic machine operation, resident POCUS supervision, and ordering and documenting POCUS exams. Post-training, 44% of providers reported performing more POCUS exams, 44% reported documenting their POCUS in the EMR more often clinically, 57% were more likely to encourage residents to perform scans, and 14% were more likely to perform a POCUS before ordering a comprehensive ultrasound. The study also observed an increase in the number of scans performed post-intervention (more than double). The SE intervention addressed challenges such as resource limitations, and feedback from participants highlighted the program's positive impact, particularly in reducing intimidation and fostering a desire for further training. While self-reported data and limited survey completion pose limitations, the increase in POCUS scans and positive feedback underscore the intervention's potential.  Conclusions: This pilot study demonstrates the feasibility and initial impact of integrating a SE into an academic ED setting. Further research is warranted to assess the specific effects on provider comfort and clinical decision-making with POCUS. The findings support the value of a dedicated SE in enhancing EPs' POCUS proficiency, promoting ongoing education, and ultimately improving patient care.