Barriers and facilitators to point-of-care ultrasound use in an academic emergency department by perceived usability

While use of point-of-care ultrasound (POCUS) has become widespread in emergency medicine, its adoption and usage among emergency clinicians is variable. In this study, we explored the barriers and facilitators to POCUS use among emergency medicine clinicians in a tertiary care emergency department in the United States by clinical role and perceived usability of POCUS. We initially administered a quantitative survey via REDCap and used a validated technology usability scale to categorize clinicians into tertiles of low, moderate, and high, based on perceived utility of POCUS. Subsequently, a purposeful sample in each category participated in semi-structured interviews until thematic saturation was reached (9–10 per category, 29 total). The qualitative interviews were analyzed using Braun and Clark's content analysis approach. A coding scheme was developed through initial review of 20 % of the transcripts, followed by operational definitions of codes, concept and category development, and selection of representative quotes. Analysis was supported by Dedoose software. We identified 41 % (12/29) as high POCUS users, 31 % (9/29) as moderate, and 28 % (8/29) as low, based on perceived usability. Interviewees consisted of 24 % (7/29) attendings, 28 % (8/29) residents and 48 % (14/29) advanced practice providers (APPs). Attendings made up 50 % in the high POCUS group and 75 % of the low POCUS group were APPs. In the low group, the lack of prior and present POCUS training was a major barrier to POCUS use. The lack of time during clinical shifts was a major barrier to POCUS utility in the high and low groups. Availability of POCUS machines in clinical spaces was identified as a facilitator to POCUS use in the medium group. Participants reported that POCUS facilitates patient disposition and clinical supervision enhances its use. Early POCUS education in professional school and continued POCUS training in clinical practice could facilitate POCUS use clinically. Structured POCUS courses and continued medical education programs may provide protected time to learn and practice POCUS. Moreover, accessible and standardized machines in the clinical environment could improve POCUS usage.