Current Use and Barriers to POCUS in Women’s Health: A National Survey of Veterans Affairs Medical Centers

Background: Point of care ultrasound (POCUS) has become an invaluable tool in healthcare across multiple disciplines. For the past 30 years, obstetricians and gynecologists in many hospitals have had access to ultrasound equipment and commonly utilize it in labor and delivery suites and emergency rooms for a broad range of conditions. POCUS can be divided into gynecologic and obstetric applications—the latter can be further categorized into fetal POCUS and maternal POCUS. While fetal POCUS primarily assesses the fetus, maternal POCUS is crucial for evaluating conditions that impact a mother's health during pregnancy, intrapartum, and postpartum, such as cardiopulmonary status. The COVID-19 pandemic highlighted the importance of maternal POCUS for timely diagnosis and management, which can ultimately reduce maternal morbidity and mortality. This study aimed to characterize the current use of maternal POCUS, identify barriers to its adoption, and explore opportunities for greater integration into clinical practice nationally among Women’s Health (WH) departments within the Veterans Affairs (VA) healthcare system. Methods: A prospective observational study was conducted from June 2019 to March 2020 through a web-based survey distributed to all VA medical centers. The survey was first distributed to all chiefs of staff about facility-level POCUS use, training, competency, and policies. A follow-up survey was sent to all WH chiefs to obtain service-level data on diagnostic and procedural POCUS use, training needs, workflows, and equipment availability. Statistical analysis utilized the Chi-squared test to uncover associations between POCUS use and various group characteristics, with a significance threshold of p<0.05. Results: Response rates were 100% among chiefs of staff (n = 130) for the facility-level survey and 77% among WH chiefs (n = 61) for the service-level survey. Diagnostic or procedural POCUS was used by only 30% of all WH groups. The most frequently reported diagnostic applications included assessment of the uterus (23%), ovaries (23%), and intrauterine pregnancy (16%). The most frequently identified procedural application identified was intrauterine device insertion, reported by 23% of the groups. Key barriers to POCUS use included a lack of equipment (56%), lack of trained clinicians (49%), insufficient funding for training (28%), and lack of support staff (26%). While 69% of WH chiefs expressed support for POCUS training, only 23% of chiefs reported having a structured process for obtaining POCUS training for their clinicians. This discrepancy underscores the need for enhanced education and awareness initiatives to align clinician perspectives with the growing benefits of POCUS in clinical practice. Conclusion: This national survey highlighted the low utilization of maternal POCUS among WH clinicians in the VA healthcare system and pointed to critical barriers, including equipment shortages and training gaps. Addressing these barriers through enhanced training, resource allocation, and leadership support is essential to fully leverage the potential benefits of POCUS use in maternal care. Future efforts should focus on evaluating the impact of improved POCUS training and investment in POCUS infrastructure on maternal health outcomes.