Errors in Point-of-Care Ultrasound Quality Assurance Data: A Descriptive Study

Area of Science:

• Emergency Medicine
• Medical Imaging
• Quality Assurance

Background:

• Point-of-care ultrasound (POCUS) is increasingly used in emergency departments (EDs).
• While POCUS accuracy is studied, data on error characteristics and clinical impact in the ED are limited.
• Quality assurance (QA) is crucial for maintaining high standards in POCUS practice.

Purpose of the Study:

• To assess the frequency and characteristics of POCUS errors identified during QA.
• To categorize POCUS errors as acquisition or interpretive.
• To identify critical errors (CEs) with potential for serious patient harm.

Main Methods:

• Retrospective review of 14,763 POCUS examinations from May 2022 to December 2023 across three teaching EDs.
• Errors categorized as acquisition or interpretive; CEs defined by expert consensus.
• Data analyzed using descriptive statistics and Fisher's exact test.

Main Results:

• A total of 102 POCUS errors (0.69%) were identified, most commonly in cardiac and EFAST scans.
• Interpretive errors constituted 78% of cases; 28% were CEs (0.20% of all scans).
• Junior residents (PGY1/PGY2) made significantly more errors than senior residents (PGY3), particularly for clinically indicated scans.

Conclusions:

• POCUS errors are infrequent, with interpretive mistakes by junior residents being most common.
• A significant proportion of errors were classified as critical, indicating potential clinical risk.
• Further multi-site, longitudinal research is needed to understand and mitigate high-risk POCUS errors.