Hospitalist Use of Point-of-Care Ultrasound During the COVID-19 Pandemic at a Single Academic Tertiary Care Center

Problem: Point-of-care ultrasound (POCUS) use is limited by availability of standardized training and evaluation. Although the diagnostic accuracy of point-of-care ultrasound is superior to chest x-ray (CXR) for certain pulmonary indications, POCUS is underused. Approach: A group of 19 hospitalists at MaineHealth Maine Medical Center participated in just-in-time training in pulmonary POCUS in mid-March 2020. The annual rate of CXRs ordered per shift was measured over a 3-year period to determine whether POCUS training resulted in a change in CXR ordering. CXR ordering rates were also evaluated among a group of 4 experienced POCUS users during the COVID-19 pandemic. Outcomes: The POCUS training did not affect the rate of CXRs ordered by physicians who received training. A non-significant decrease in CXR ordering was seen among experienced POCUS users during the COVID-19 year only (CXRs ordered per shift 0.18 versus 0.10 for pre-COVID-19 and COVID-19 years, respectively, P = .0504). The decrease in CXR ordering by experienced POCUS users during the COVID-19 year suggests that early POCUS adopters with longitudinal training have greater use. Capacity strain (ie, personnel or lengthy disinfection procedures required for CXR) during the COVID-19 year may have also encouraged experienced POCUS users to choose POCUS over CXR for immediate bedside evaluation rather than a delayed work up. Experienced POCUS users may have been disincentivized as capacity strain in the post-pandemic era resolved. Next steps: Short-term POCUS training alone is not sufficient to increase use. This study supports literature that longitudinal training is necessary to increase POCUS use, notably among novice users. Developing standards for longitudinal POCUS training and evaluation may facilitate POCUS integration into clinical practice.