Start spreading the news: a deliberate approach to POCUS program development and implementation

Abstract

While there is an expanding body of literature on Point-of-Care Ultrasound (POCUS) pedagogy, administrative elements that are necessary for the widespread adoption of POCUS in the clinical environment have received little attention. In this short communication, we seek to address this gap by sharing our institutional experience with POCUS program development and implementation. The five pillars of our program, selected to tackle local barriers to POCUS uptake, are education, workflow, patient safety, research, and sustainability. Our program logic model outlines the inputs, activities, and outputs of our program. Finally, key indicators for the monitoring of program implementation efforts are presented. Though designed for our local context, this approach may readily be adapted toward other clinical environments. We encourage others leading the integration of POCUS at their centers to adopt this approach not only to achieve sustainable change but also to ensure that quality safeguards are in place.

Main text

Though Point-of-Care Ultrasound (POCUS) program leaders are generally well versed in POCUS education, they may lack the tools to support the broader implementation of POCUS in the clinical environment. While there is an expanding body of literature on POCUS pedagogy [1,2,3], administrative and logistical elements that are necessary for the widespread adoption of POCUS have received little attention [4, 5]. Considering the value proposition of POCUS to enhance patient care [6], we set out to increase the uptake of POCUS by general internists at the Ottawa Hospital, a tertiary care academic center. Using concepts from the literature on change management, quality improvement, and program evaluation, we developed a comprehensive approach to program development and implementation. In this paper, we share our approach as a model to support others looking to achieve the safe uptake of POCUS at their institution.

Understand your local environment

The first step to any change initiative is to gain an understanding of the operational environment [7]. A thorough understanding of local barriers and enablers, including stakeholder perceptions and readiness for change [8,9,10], organizational culture, and infrastructure is crucial [7].

Our program stakeholders include senior management, divisional leadership, content experts, non-clinical partners (biomedical engineering and information technology services), and end users. Stakeholder engagement was achieved using different mediums including informal interviews, divisional meetings, and online surveys.

The Ottawa Hospital has established programs in Emergency Medicine Ultrasonography (EMUS) and Critical Care Ultrasonography (CCUS). In addition to offering a wealth of experience in program development, these programs have a mature POCUS infrastructure, including hospital-based archiving, that can readily be expanded to other departments. Our environmental survey also showed that there is strong leadership support both at the senior management and divisional level for the implementation of POCUS in General Internal Medicine (GIM).

In addition to these enablers, we identified barriers to the broader uptake of POCUS in our division. Similar to barriers that have previously been described [11], lack of training, lack of time, lack of quality safeguards, and lack of evidence were quoted as being prohibitive. Finally, we identified that previous attempts to integrate POCUS in the division had been unsuccessful due to the lack of sustained efforts.

Develop and communicate a vision of change

Once we had developed a good understanding of our local barriers and enablers, we set out to establish our mission, values, and vision (Table 1) [12]. These are aligned with our organization’s strategic goals [13] and will give direction to our change efforts [14, 15].

Table 1 Mission, values, and vision

Remove obstacles [14]

Our next step was to identify strategies that would address each barrier (Table 2). This exercise allowed us to come up with the five overarching pillars of our program.

Table 2 GIM POCUS program goals and pillars

Plan program resources, activities, and outputs

Once we had identified the key elements of our program, we set out to plan our specific deliverables [16]. We present a logic model for our program (Table 3). A logic model is a systematic and visual way to outline the different elements of a program, from the inputs required to operate the program, the activities the program will deliver, and the outputs that will result from program implementation [17].

Table 3 GIM-POCUS program logic model: resources, activities, and outputs

Monitor

Finally, we planned for monitoring of our implementation efforts. We selected indicators that could feasibly be collected, would adequately signal change, and would be actionable (Table 4) [18,19,20].

Table 4 Indicators to monitor program implementation

Conclusion

In this paper, we have—through sharing our institutional experience—sought to address a gap in the literature regarding POCUS implementation in the clinical environment. A strength of our program is its focus on quality and patient safety. Our program is designed specifically for our local context but may readily be adapted toward other clinical environments. As such, we encourage others leading the integration of POCUS at their centers to adopt this approach not only to achieve sustainable change but also to ensure that appropriate quality safeguards are in place.