Impact Evaluation After Implementing a Co-Designed Point-Of-Care Ultrasound Program at a Veterans Affairs Emergency...

Point-of-care ultrasound (POCUS) is an important diagnostic bedside tool, yet a gap remains between Emergency Department (ED) POCUS programme implementation and achieving sustained POCUS use and retention. We performed an impact evaluation of a co-designed POCUS programme implementation intervention and assessed programme acceptability, effectiveness and feasibility.

Our mixed-methods cohort study implemented a co-designed, multifaceted intervention using the consolidated framework for implementation research at a single Veterans Affairs ED (November 2021-October 2022) to enhance POCUS usability and sustainability, including provider education, image review and archival. Primary ED providers (20/25) participated in hands-on POCUS training sessions between February and May 2022. We assessed POCUS program acceptability, appropriateness, and feasibility via provider pre/post-course surveys, interviews, and health record data using a validated tool (AIM-IAM-FIM; assessing ED POCUS, radiology ultrasound orders, and ED metrics).

ED POCUS significantly increased (from 72 to 267 scans, p < 0.001) 6 months post-intervention, with no significant change in radiology ultrasounds ordered (from 355 to 361, p = 0.417) or ED length-of-stay (from 6.7 to 7.5 h, p = 0.0849). Cardiac, deep vein thrombosis (DVT), soft tissue, musculoskeletal, and biliary ED POCUS were most common; and radiology studies were DVT, biliary and scrotal ultrasound. The pre/post-intervention surveys showed provider comfort with performing and teaching diagnostic and procedural POCUS changed minimally. All respondents approved of POCUS use and education (acceptability), endorsed clinical tool applicability (appropriateness) and stated the course/training was doable (feasibility).

POCUS use increased post-program implementation. Future studies should evaluate program sustainability, incorporate methods to reduce radiology ultrasound and improve patient-centered outcomes.