Implementation of Point of Care Ultrasound in the Intensive Care Unit: A Quality Improvement Project

Background: Point of Care Ultrasound (POCUS) is the use of portable ultrasound technology by bedside clinicians for rapid patient assessment. POCUS has been found to decrease the time to accurate diagnosis and improve patient outcomes in the ICU (Yoshida et al., 2023). However, POCUS is underutilized within the critical care setting, particularly in rural communities. Barriers to POCUS include lack of training for providers and a lack of proper equipment. Local Problem: POCUS is not in use within the critical care service line at a Idaho hospital. While ultrasound machines are available for use within the ICU, the primary barrier to implementation is a lack of training in conducting POCUS assessments and interpreting the images gathered. This project aims to implement this technology in the ICU unit at this Idaho hospital. Methods: Methods included assessing the available current evidence for POCUS use within the critical care setting, developing an evidence-based clinical practice guideline for POCUS use in the ICU, and implementing POCUS in the initial physical assessment of patients in the ICU. Usability, feasibility and satisfaction of POCUS use among the providers on the ICU was also evaluated. Interventions: Interventions included a four-hour clinical practice educational session to begin the clinical implementation. This focused on cardiac POCUS, and included a mixture of ultrasound lecture, hands-on practice using live models, and case study review of abnormal findings. Providers were then asked to begin using POCUS in their initial physical examinations of patients admitted to the ICU. Study of the interventions was conducted through pre- and postsurvey data from the providers and a limited chart review of patients admitted to the ICU during the implementation period. Data analysis was conducted using a Mann-Whitney U test to assess for statistical significance. Results: There was a statistically significant increase in participants' pre/post confidence in performing left ventricle (LV) and right ventricle (RV) assessments using POCUS (U=12, p < .05). Overall increase in confidence in POCUS use was not statistically significant (U= 16.75 p < .05). All surveyed providers (n=8) agreed that POCUS was valuable to their practice and stated that they would continue to use it in the future. All providers (n=8) answered that they were more confident in using POCUS after the educational training session. Seven out of eight providers had used POCUS in practice since the educational training session. In a chart review, three out of ten charts showed evidence of POCUS examination during the initial physical assessment of patients admitted to the ICU. Conclusion: The results indicate that all providers thought POCUS was useful to practice and planned to continue using it in practice. This suggests that POCUS is a useful physical assessment tool in critical care and should be more widely implemented. Future projects could focus on other types of POCUS exams, improving documentation of POCUS exams in the Electronic health record (EHR), and patient outcomes when POCUS is used in their initial physical assessment.