POCUS in Pediatrics

Do you work in a children’s hospital? Do you perform POCUS? Do you ever wonder if other divisions in your hospital are using POCUS as well?

Point-of-care ultrasound (POCUS) is growing quickly across all medical specialties, including pediatrics. Within pediatrics, POCUS is being utilized in the emergency department, intensive care unit, operating room, clinic as well as on the inpatient floor. While the scope of practice may differ across sub-specialties, the issues pertaining to education, training, credentialing, equipment procurement, and workflow solutions are universal.A Abo

At Children’s National Medical Center (CNMC) in Washington, DC, we have established a hospital-wide oversight committee for POCUS, which is a multi-disciplinary effort throughout the institution. Our aim is to standardize the use of POCUS across the hospital with respect to
1) education/training/credentialing,
2) documentation/image archival, and
3) maximizing the financial benefit.

Education, Training, and Credentialing

Each division who uses POCUS should have a champion who is responsible for the education and training of both trainees and faculty within the division. Many faculty in pediatrics, and pediatric sub-specialties, were not trained in POCUS as part of their residencies and fellowships; therefore, the opportunity to learn POCUS as a faculty member is incredibly important. Once competent in POCUS, faculty should have the ability to become credentialed in POCUS. A hospital-wide POCUS initiative can promote POCUS education across divisions through collaboration. Divisions can share POCUS curriculums with one another in addition to sharing resources. For example, divisions can bring their resources together and host a hospital-wide POCUS course. Furthermore, at CNMC, we recently received a grant to establish an ultrasound simulation program, which will be incorporated into our hospital-wide simulation program.

Documentation and Image Archival

Divisions that are using point-of-care ultrasound for medical decision making or procedural guidance should be documenting their findings in the medical record and archiving the appropriate images. In an ideal world, the ultrasound images would be accessible in the medical record, along with the documentation. The ability to view the POCUS images, by all clinicians providing care, improves the flow of knowledge among clinicians and in turn, improves patient care. From a workflow standpoint, the ability to archive the images in a centralized location, with the ability to connect the images to the electronic medical record, may be better accomplished as a hospital-wide initiative.

Maximizing the Financial Benefit

Collaboration among the divisions using point-of-care ultrasound can have a financial impact as well. For instance, when purchasing ultrasound equipment, the cost per machine is lowered when purchased in bulk. Furthermore, once the infrastructure is in place with respect to credentialing as well as the ability to document and store ultrasound images, clinicians may have the ability to bill for their services.

In order to accomplish the aforementioned aims, it is crucial to have hospital-wide support. To that end, we have strong partnerships with other clinical divisions, such as Radiology and Cardiology, who share their ultrasound expertise with the POCUS community. Furthermore, we have established relationships with other groups as well, such as information technology, purchasing, legal, biomed, and credentialing.

Are you interested in doing something similar at your institution? Wondering where to start? One suggestion is to send out a survey to all the division chiefs to better understand if POCUS is currently being used (or will be used in the future) in their respective divisions. Be sure to ask if the division has a POCUS champion. From there, plan a meeting with all the champions and start a discussion on how to improve POCUS at your institution. For a resource, check out the following reference.

Strony R, Marin JR, Bailitz J, et al. Systemwide clinical ultrasound program development: an expert consensus model. West J Emerg Med. 2018; 19:649–653.

 

Do you work in a children’s hospital? Do you perform POCUS? Do you ever wonder if other divisions in your hospital are using POCUS as well? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community.

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Alyssa Abo, MD, FAAP, FACEP, is Director of Clinical Ultrasound in Emergency Medicine, and Chair of the Hospital Oversight Committee for Point-of-Care Ultrasound at Children’s National Medical Center in Washington, DC, as well as Associate Professor of Pediatrics and Emergency Medicine at George Washington University School of Medicine and Health Sciences in Washington, DC.

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