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Point-of-care ultrasound (POCUS) oversight and safety

January 17, 2020
Risk Management Ultrasound
Diku Mandavia
By Diku Mandavia

The stethoscope, the blood pressure monitor, and point-of-care ultrasound (POCUS). They are all powerful tools that clinicians have come to rely on to augment diagnostics, choose treatments, and make important decisions about referral. Moreover, each is portable and easy to use in a variety of settings and situations.

However, POCUS stands apart from the others when it comes to the sheer sophistication of the technology as well as the skill required to perform exams and interpret the images it delivers.

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Yet, POCUS has enjoyed rapid adoption in hospitals and private practices. In fact, one recent study estimates that on average a general practitioner’s office performs anywhere from 131 to 601 ultrasound examinations annually.

No doubt, POCUS is advancing care in hospitals at the bedside, in the ER, OR, and the ICU, and also out in the field in remote areas. POCUS is a valuable and life-saving tool that also reduces cost which is very important in today’s value based care world.

Despite this, in a recent special report, the ECRI Institute named POCUS among its Top 10 Health Technology Hazards for 2020. The Institute claims, “a lack of oversight regarding the use of point-of-care ultrasound—including when to use it and how to use it—may place patients at risk and facilities in jeopardy.”

The Institute cites a host of safety concerns. These include POCUS not being used when warranted, misdiagnoses, inappropriate use of the modality, and overreliance on POCUS when a more comprehensive exam by an imaging specialist is indicated.

As with any medical technology, safety must come first and POCUS is no exception. When rapid adoption—and the training that should go with it—outpaces safeguarding patients, it poses a significant problem for the healthcare community.

The ECRI Institute’s report overlooks a key fact, however. It fails to mention that presently there are numerous POCUS vendors selling a wide range of POCUS devices—and among them, both manufacturer commitment and product quality vary a great deal. Simply put, choosing the right partner vendor for an organization’s POCUS needs is the first step toward ensuring patient safety.

Apples and oranges; need for training
Not all POCUS technologies are created equally. In its genuine attempt to bring transparency to the safety issue, the ECRI Institute has lumped all POCUS tools together. However, the product pool is so vast and diverse it’s like comparing apples and oranges.

Over the past few years there have been a number of POCUS devices brought to market that are far lower in cost than traditional POCUS technologies. While many of these tiny, inexpensive devices are now available, the technology may be inferior. For example, lack of proper testing, poor quality control, cheap hardware or faulty software can all lead to adverse affects when these tools are used on patients.

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