Seeing Ghosts: A Quality Improvement Intervention to Decrease Phantom Scanning Through Increased Image Archiving of POCUS by Internal Medicine Residents

Point of care ultrasound (POCUS) is used in internal medicine (IM) to augment clinical decision making and improve procedural safety. Institutionally-supported archiving software can help learners track scan numbers and receive feedback on image acquisition and interpretation. At the University of Saskatchewan, IM residents use POCUS for procedures and assessments but rarely save images, limiting feedback opportunities. Our quality improvement project aimed to increase the number of POCUS images saved by Postgraduate Year One (PGY-1) IM residents, targeting over 75% of non-procedural scans and ensuring over 50% of residents save at least one scan. This quality improvement project was conducted on a clinical teaching unit at an academic hospital over two years. We used four Plan-Do-Study-Act (PDSA) cycles each year to measure the percentage of non-procedural scans saved by PGY-1 IM residents. As a balance measure, we compared the number of scans performed historically and during the study period to monitor for changes in usage. Data was collected using an ultrasound sign-out sheet. At baseline, no diagnostic scans were saved by PGY-1 IM residents. Post-intervention, 56% of scans were archived in cohort one and 76% in cohort two. Additionally, 79% of residents in cohort one and 94% in cohort two archived at least one scan. The balance measure improved from 1.13 in the first year to 2.25 in the second, suggesting image archiving is not a deterrent to performing scans. Through this intervention, we significantly increased the archiving of non-procedural scans by PGY-1 IM residents. We advocate for implementing a formal POCUS archiving system to promote quality assurance in residency programs.