Abstract

Exploring the views of Point of Care Ultrasound practitioners for widespread implementation in community settings in the UK

The problem:
Point of Care Ultrasound (POCUS) is a currently available and rapidly developing technology but still not widely used in the UK. Community POCUS in prehospital and primary care settings could help to prioritise initial treatment, procedures and appropriate patient referral or conveyance to an appropriate secondary care setting. Recent reviews suggest that image quality, portability and cost of ultrasound devices are improving, that POCUS is increasingly being used by general practitioners and emergency practitioners across the world, and that generalists can safely use ultrasound in a range of clinical settings to aid diagnosis. As further evidence of community POCUS use and impact is needed in the UK, we aimed to explore the views of practitioners who use ultrasound in practice on the role of POCUS and perceived barriers and facilitators for implementation in UK community settings.

The approach:
We conducted a qualitative interview study with practitioners who use point of care ultrasound in practice. Participants were from community and secondary care settings, and interviews were conducted online via Microsoft Teams. A purposive sampling approach was used to recruit eligible participants through an inclusion criterion. Following ethics approval, participants were recruited by using a flyer advertising the study on social media (Twitter) and websites of relevant research groups. This was enhanced by a snowballing technique, with participants already identified serving as key informants to recruit further eligible and willing participants to the study. Data were collected using individual semi-structured interviews lasting 40 – 60 minutes. Interviews were recorded, transcribed verbatim and analysed using a Framework approach assisted by NVivo 12 software.

Findings:
In total, 16 practitioners, aged between 40 and 62, with a range of professional backgrounds including paramedics, prehospital emergency physicians, general practitioners and allied health professionals (radiologist, sonographer, physiotherapist), participated in interviews.

Participants identified structural factors as perceived barriers to the deployment of community POCUS. These factors included resource requirements for purchase and deployment of actual devices, sufficient time for training and inclusion in the workflow, and a suitably skilled workforce; special attention to training, education and support needs; as well as ensuring proper governance, guidelines and quality assurance for the use of POCUS in such settings.

To enable implementation of POCUS in community care settings, participants also identified process factors requiring consideration. These included more robust evidence to reinforce perceptions of improved patient outcomes and experience, enhanced ease of use in assisting decision making, and also consideration of potential unintended consequences or incidental findings. Workforce considerations included need for supportive staff, champions and leadership.

Implications:
POCUS could be a useful tool for improving community assessment and health outcomes, but structural and process factors identified in this study need to be addressed for community POCUS to become a reality.