Barriers to Adoption
Despite the many benefits of POCUS, a study published in the Western Journal of Emergency Medicine highlighted the utilization gap between academic emergency departments and other emergency settings. The study surveyed ED directors in five states (Arkansas, Hawaii, Minnesota, Vermont and Wyoming) in 2010. The survey was able to determine the proportion of emergency physicians using POCUS and identify barriers to POCUS use in these states.
The survey demonstrated that availability of POCUS varied by state from 34% to 85%. Availability was associated with higher ED visit volume and percent of emergency physicians who are board certified/board eligible in emergency medicine.
The study’s authors identified three main barriers to the use of bedside ultrasound:
1. Lack of training (70 percent)
2. Expense (39 percent)
3. Limited (real or perceived) need for ultrasound (32 percent)
Notably, of the EPs who said that they weren’t using POCUS because of limited need, the authors predicted that many would change their opinions if they were given more training. A substantial number of the EDs in the study also reported that POC ultrasound was not available due to high cost, demonstrating a market need for lower-cost devices.
Given the triple barriers of training, cost, and perceived limited need for bedside ultrasound, what can be done to increase its use? Ultimately, the study’s authors recommended leveraging “recent educational and technical advancements” to get POCUS into the hands of more doctors. The authors noted that the widespread use of asynchronous learning platforms has made it easier than ever to learn POCUS at little (if any) cost. Education-oriented websites such as American College of Emergency Physicians’ sonoguide.com continue to grow, as do free open-access medical education forums on websites, blogs, video logs, and other internet-based resources.
Bottom line: To increase the use of bedside ultrasound, doctors need ultrasound devices that are affordable, portable, and easy to learn. At the end of the day, increasing the use of bedside ultrasound in the ED will be a tandem effort. By combining access to training with more affordable ultrasound devices, widespread use of POCUS can become a reality.