Utilisation and barriers of PoCUS in a rural emergency department – A quality improvement project
Bibliographic record
Abstract
Introduction: Point-of-care ultrasound (PoCUS) has been recognised as a tool that leads to more definitive diagnoses and enhances clinical decision-making in rural emergency departments (EDs) where diagnostic imaging is limited. We aimed to determine the current utilisation, barriers and solutions to using PoCUS in this rural Saskatchewan ED. Methods: Physicians working in the ED participated in a semi-structured interview. An online survey, administered via SurveyMonkey post-interview to provide further context, was used to support qualitative approaches. Interviews were recorded, transcribed and then analysed using inductive interpretation. Results: Seven physicians completed the quantitative survey with a response rate of 70%. Ten physicians were interviewed with a response rate of 100%. Themes identified were that physicians in this community’s ED perceived their skill level as determining whether a scan was diagnostic or not, rather than the specific PoCUS application itself. In addition, they performed scans primarily for the purpose of triage. Inadequate training, Core IP certification certification requirement and intradepartmental logistics were barriers to PoCUS utilisation. Conclusion: This study showed that ED physicians in this community perceived PoCUS as a clinical adjunct and as a tool to triage patients for further imaging. Results highlight the need to have accessible training for rural physicians to increase PoCUS utilisation, awareness of current Saskatchewan PoCUS guidelines and education on diagnostic applications of PoCUS. Increased use of PoCUS for specific scans could decrease the need for formal imaging and the associated healthcare system resources. Introduction: L’échographie au point d’intervention (ÉPI) est reconnue comme un outil permettant d’établir des diagnostics plus définitifs et d’améliorer la prise de décision clinique dans les services d’urgence ruraux où l’imagerie diagnostique est limitée. Nous avons cherché à déterminer l’utilisation actuelle, les obstacles et les solutions à l’utilisation de l’ÉPI dans ce service d’urgence rural de la Saskatchewan. Méthodes: Les médecins travaillant aux urgences ont participé à un entretien semi-structuré. Une enquête en ligne, administrée via SurveyMonkey après l’entretien pour fournir un contexte supplémentaire, a été utilisée pour soutenir les approches qualitatives. Les entretiens ont été enregistrés, transcrits puis analysés à l’aide d’une interprétation inductive. Résultats: Sept médecins ont répondu à l’enquête quantitative, soit un taux de réponse de 70%. Dix médecins ont été interrogés avec un taux de réponse de 100%. Les thèmes identifiés sont les suivants: les médecins du service d’urgence de cette communauté considèrent que leur niveau de compétence détermine le caractère diagnostique ou non d’un examen, plutôt que l’application spécifique de l’ÉPI. En outre, ils effectuaient des scanners principalement à des fins de triage. Une formation inadéquate, l’exigence d’une certification de praticien indépendant de base et la logistique interne au service étaient des obstacles à l’utilisation de l’ÉPI. Conclusion: Cette étude a montré que les médecins des services d’urgence de cette communauté percevaient l’ÉPI comme un complément clinique et un outil de triage des patients en vue d’un examen d’imagerie plus approfondi. Les résultats soulignent la nécessité d’une formation accessible aux médecins ruraux pour accroître l’utilisation de l’ÉPI, la connaissance des lignes directrices actuelles de l’ÉPI de la Saskatchewan et l’éducation sur les applications diagnostiques de l’ÉPI. L’utilisation accrue de l’ÉPI pour des examens spécifiques pourrait réduire le besoin d’imagerie formelle et les ressources du système de santé qui y sont associées.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".