Perceived Barriers in the Use of Point of Care Ultrasound in the WWAMI Region

Objective: The use of point-of-care ultrasound (POCUS) has increased in use over the last two decades. Despite reports of increased use of POCUS at academic emergency departments, the overall trends in use of POCUS in rural emergency departmentsremains low. We aimed to define the perceived barriers to the use of emergency POCUS by physicians in the five-state WWAMI region (Washington, Wyoming, Alaska, Montana, and Idaho). Methods: A 26-question survey was sent to emergency physicians who practice in the WWAMI region. This was a convenience sample obtained from list-serves of emergency medicine and emergency ultrasound societies. The survey was analyzed and descriptive results were obtains. Results: We sent our survey to a total of 353 providers. 65 respondents completed the survey, for a response rate of 18.4%. Most physicians reported their clinical practice site as being in Alaska, Washington or Idaho, and nearly all of them (96%) had access to an ultrasound machine owned by the emergency department group. 57% of respondents work in an emergency department with an annual census of less than 40,000 patients per year. 60% noted having participated in emergency POCUS after their residency training period, most commonly through a continuing medical education course. Participants were most confident performing emergency POCUS for trauma (FAST exam) and using POCUS for procedural guidance.Respondents noted being less confident performing POCUS for focused echocardiography, biliary, lung and intravascular volume assessment. The most commonly identified barriers to using emergency POCUS were concerns about liability, difficulty with image interpretation, lack of training, and lack of POCUS support personnel. Discussion: Emergency physicians from the WWAMI states identify lack of training as a primary barrier to regular use of pointof-care ultrasound in their practice. Most participants identified telesonography and web-based distance learning as methods to enhance their POCUS education.