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

Background: 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. The VA's Simulation Learning, Education
and Research Network (SimLEARN) and Specialty Care Centers of Innovation (SCCI) have launched
a collaborative initiative to develop a national POCUS training program. The goal of this
collaborative training program is to teach VA providers basic diagnostic and procedural
applications of POCUS. The proposed project will evaluate the effectiveness of an immersive
POCUS training course developed by SimLEARN on provider skill acquisition and retention,
frequency of use, and identify barriers/facilitators to POCUS use at participating VHA
facilities.

Methods: Approximately 120 participants from a convenience sample of 20 diverse VA facilities
will participate in a 2.5-day immersive POCUS training course at the SimLEARN National
Simulation Center in Orlando during fiscal year 2017. The investigators' evaluation plan will
collect data from facility Chiefs of Staff, providers from facilities participating in POCUS
training, and providers from wait-listed facilities at different time points using different
assessment tools: VA Facility POCUS Survey, Provider POCUS Survey, Brief Provider POCUS
Survey, Pre-/Post-course Knowledge and Skills Test, and Coding Data.

Objective 1: Evaluate provider skill acquisition and retention, and frequency of POCUS use
after participation in the POCUS Training Course. Pre- and post-course testing will be used
to assess acquisition of knowledge and technical skills to perform POCUS exams. Post-course
testing for knowledge and skill retention, and frequency of use, will be performed 6-9 months
after the training course.

Objective 2: Determine the effect of the POCUS Training Course and implementation
facilitation on facility-level frequency of POCUS use. Facilities with providers that
infrequently use POCUS will be eligible to participate in the POCUS Training Course. However,
not all facilities will be able to be accommodated in the 1st year of the training program,
requiring a facility waiting list. Facilities with providers participating in the POCUS
Training Course will be compared to wait-listed facilities with regard to frequency of POCUS
use. Using the Brief Provider POCUS Survey, frequency of POCUS use by providers in both
participating and waitlisted facilities will be compared. 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.

Objective 3: Determine provider and facility-level barriers and facilitators to POCUS use.
Provider and facility-level barriers will be assessed using 3 tools: Provider POCUS Survey
(trained providers), Brief Provider POCUS Survey (wait-listed and participating facilities),
and Facility POCUS Survey (all facilities). Differences in barriers reported and their
relationship to frequency of POCUS use will be compared.

Objective 4: Development of POCUS Champions course to facilitate local implementation by
addressing facility-level barriers. The POCUS Champions course will address several
facility-level barriers to implementation that have been identified by the PEI: lack of image
archiving, limited access to ultrasound machines, undefined credentialing/privileging
processes, need for a quality assurance process, and lack of trained providers. The POCUS
Champions course will include an annual 3-day boot camp, bi-monthly conference calls, and
ongoing mentorship. The goal of the 3-day boot camp will be for Champions to prepare a local
implementation plan that can be presented to their facility's leadership. During the
bimonthly conference calls, a brief didactic on a focused topic will be presented followed by
an update on local progress from each site. The initial goal of the POCUS Champions course is
to facilitate implementation of POCUS use in VA facilities, starting with 4-6 facilities that
can serve as models for other facilities. The research to date has identified these elements
as core components of a successful POCUS program. The POCUS Champions course will support
progress on intermediate milestones towards ensuring these core components are in place, to
facilitate adoption, reach, and sustainment. This provides a roadmap to sustainable POCUS
use.

Deliverables: The primary deliverable will be report that will summarize the effect of
training on provider skill acquisition and retention, frequency of use of POCUS, and barriers
and facilitators to POCUS implementation. This project will guide SimLEARN's and SCCI's
efforts to develop a National POCUS Training Program and implement POCUS use nationally in
the VA healthcare system. Additionally, this report may serve as a roadmap for the VHA for
implementation of similar simulation-based educational innovations.

Inclusion Criteria:

Selection of VA facilities invited to participate in the national POCUS training course was
based on data from a national needs assessment conducted by the VA's Health Analysis and
Information Group. VA facilities that meet all of the following inclusion criteria are
eligible to send physicians to participate in the POCUS training course:

1. Chief of staff desires POCUS training for his/her facility

2. >=2 Service Chiefs from emergency medicine, critical care medicine, or hospital
medicine desire training for his/her physicians, AND

3. >=1 portable ultrasound machine(s) available to physicians within these services

Exclusion Criteria:

1. Chief of staff does not desire POCUS training for his/her facility

2. <2 Service Chiefs from emergency medicine, critical care medicine, or hospital
medicine desire training for his/her physicians, OR

3. No portable ultrasound machine(s) available to physicians within these services