Interdisciplinary Point-of-Care Ultrasonography (POCUS) Program Led by Nephrology

Background: POCUS has been touted as the fifth pillar of the physical exam: inspection, palpation, percussion, auscultation and insonation. The use of POCUS in nephrology has been growing throughout the country, and now Nephrology has a unique position to increase the use of POCUS in both nephrology and medicine. We describe the POCUS program at our institution unifying various programs under one umbrella. Methods: One lead nephrologist has developed a curriculum and POCUS has been taught as part of the nephrology training curriculum since 2021. Bi-weekly hour-long sessions with a combination of didactics, hands on sessions, and image reviews to ensure both technical proficiency and diagnostic capability has been created. This is in concordance with ASDIN guidelines for certification. Our target is that Nephrology fellows will become certified 12-18 months into their fellowship and subsequently become superusers and help teach the rising first years and internal medicine residents. Results: In order to teach the residents, a bimodal approach was used with the critical care faculty teaching weeklong boot camps for interested and available residents. Alternatively, interested residents who were unable to attend the weeklong program, were given similar didactics and hands on teaching spaced out over the year by nephrology POCUS faculty. This increased the total number of residents who had POCUS exposure and improved usage of POCUS. At present, we have 32 house-staff involved. We have also started a parallel program with several hospitalists, with the same intention of establishing 1-3 super users. Presently we are using 8 Phillips Lumify devices, expanded from only a single POCUS device outside of the ICU in 2020. As we have more users, utilizing the resource effectively becomes even more important. Conclusion: We feel that Nephrology led POCUS initiatives are important because it puts the probe in the hands of users who need to optimize the tools used to master volume status and are most familiar with the physiology of many hospitalized patients. By leading POCUS initiatives throughout the hospital nephrologists can be leaders in guiding internists into the future. With nephrology championing the education of house-staff our objective to expand the program so that all of our nephrology fellows with be superusers, and expand the training to other departments.