Roadmap to success: Blueprint for enterprise-wide deployment of a point-of-care ultrasound platform, inclusive of governance, policy, education, credentialing, and quality assurance (Part 2)

Abstract

Point-of-care ultrasound (POCUS) has emerged as a cost-effective diagnostic tool that significantly enhances physical examinations. Serving as an extension of traditional examination methods, POCUS is particularly appealing to the next generation of clinicians. It holds the potential to become the modern-day stethoscope in various medical assessments and procedures. At the University of Rochester, we are in the midst of a major initiative, deploying 2,000 POCUS probes while simultaneously reinforcing compliance standards for image storage and documentation across established POCUS platforms. Three years into our 4-year deployment plan, we will discuss the evolution of our governance structure, improved utilization, continued educational initiatives, and credentialing strategies. Over the past decade, POCUS adoption has grown organically, and our goal is to implement a comprehensive strategy that ensures adherence to established protocols for image storage and documentation. At present, we have successfully deployed 1,199 probes, up from 789 in year 2, with integration across more than 70 departments and divisions within our information technology (IT) platform. Notably, this implementation has led to a 26% growth in hospital charges, highlighting the tangible impact of POCUS integration. However, achieving compliance and education among established providers continues to be a challenge. The integration of fellowship-trained POCUS physicians into various departments has been invaluable, and developing physician champions has significantly improved both utilization and compliance. Recent initiatives include transitioning from traditional bladder scanners to ultrasound (US) probes mounted on iPad stands and developing a nursing POCUS-guided US program. Nursing education has played a pivotal role in supporting this transition. Over the first 6 months, 86 US probes used by nursing staff have facilitated approximately 70,000 bladder examinations.

Keywords: Enterprise imaging; Point-of-care ultrasound; Ultrasound IT platform.

Flowchart 1:

The upper workflow is for providers using the Butterfly cloud for documentation, with automatic billing integration. This setup offers the advantage of easier quality assurance and resident documentation. Below, the auto-finalize workflow places documentation directly into EPIC, with charge capture used for billing. Providers performing procedures or previously conducting point-of-care ultrasound examinations will find this workflow more efficient. In both workflows, completed images are stored in the institutional picture archive communication system and documentation in the electronic medical record.

Flowchart 2:

2024 Point-of-care ultrasound device fleet. There are 888 active users.

Pie chart 1:

Illustrates the 2024 device fleet and its distribution. The majority of studies continue to be conducted using non-butterfly devices. BFLY: Butterfly, NBD: Non-butterfly device.

Figure 1:

One of the first ten patients seen in the family medicine clinic for abdominal aortic aneurysm screening demonstrated aortic dilatation (arrow).

Figure 2:

A case of bowel wall thickening (arrow) performed by a GI physician using a Samsung ultrasound machine. Ultrasound has now become the standard tool for physical examination.