QUERI – Quality Enhancement Research Initiative

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Evaluation of Implementation of a National Point-of-care Ultrasound Training Program

San Antonio, TX

Overview:

Point-of-care ultrasonography (POCUS) has been shown to reduce procedure-related complications from invasive bedside procedures, reduce time to diagnosis, and reduce ancillary testing, which ultimately reduces patient radiation exposure and healthcare costs. Despite its potential advantages, POCUS has not been universally adopted in healthcare due to limited numbers of providers trained in use of POCUS. VA's Simulation Learning, Education and Research Network (SimLEARN) and Specialty Care Centers of Innovation have launched a collaborative initiative to develop a national POCUS training program. The goal of this program is to teach frontline VA providers basic diagnostic and procedural applications of POCUS. The proposed project will evaluate the effectiveness of a POCUS training course on provider skill acquisition and retention, frequency of use, and identify barriers/facilitators to POCUS use at participating VHA facilities.

Objectives:

  • Evaluate provider skill acquisition and retention, and frequency of POCUS use after participation in the POCUS Training Course.
  • Determine the effect of the POCUS Training Course and implementation facilitation on facility-level frequency of POCUS use.
  • Determine provider- and facility-level barriers and facilitators to POCUS use.

Methodology:

Evaluation activities will be conducted on-site at the SimLEARN National Simulation Center in Orlando, Florida and remotely using teleconferencing software. Both qualitative and quantitative data will be collected using the following strategies.

  • A national Facility POCUS Survey was completed by all facilities in the VA healthcare system to assess readiness for implementation of POCUS. Twenty facilities willing to support their providers' participation in the POCUS training program will be recruited and randomized to early-intervention vs. delayed-intervention groups during FY17.
  • Providers from selected facilities will participate in a 2.5-day POCUS Training Course at the National Simulation Center in Orlando. Pre- and post-course testing will be used to assess acquisition of knowledge and technical skills to perform POCUS exams. Post-course retention testing for knowledge and skills will be performed 4-6 months after the training course. A brief Provider POCUS Survey will be used to determine frequency of POCUS use by providers at baseline and 4-6 months post-course.
  • Facilities in the early-intervention group will be compared to the delayed-intervention group with regard to frequency of POCUS use and bedside procedural complication rates. Using the brief Provider POCUS Survey, frequency of POCUS use by providers in both early- and delayed-intervention facilities will be compared at baseline and 4-6 months post-course. Additionally, coding data will be reviewed to assess frequency of procedures performed with and without imaging guidance and procedural complication rates comparing the two groups of facilities
  • Provider and facility-level barriers will be assessed using three tools: 1) Provider POCUS Survey completed by all participating providers, 2) Facility POCUS Survey completed by Chiefs of Staff of all VA facilities, and 3) field notes gathered by faculty from monthly conference calls and a Community of Practice website. Differences in barriers reported and their relationship to frequency of POCUS use will be compared.

Operations Partner(s): This Partnered Evaluation Initiative is a collaborative project with the VHA's Simulation Learning, Education and Research Network (SimLEARN) and Specialty Care Centers of Innovation.

Principal Investigator: Nilam J. Soni, MD, MS; contact at nilam.soni@va.gov or sonin@uthscsa.edu .