Main text
Understand your local environment
Develop and communicate a vision of change
Mission | Leverage POCUS to provide better value care, enhance patient and provider experience, and achieve better health of populations |
Values | Quality and patient safety Educational excellence Sustainability |
Vision | To achieve widespread safe use of POCUS by general internists at the Ottawa Hospital |
Remove obstacles [14]
Barrier | Goals | Program pillars |
---|---|---|
Lack of training | Deliver educational activities to allow internists to gain the cognitive and psychomotor competencies required to perform and integrate POCUS clinically | Education |
Lack of time | Establish a seamless POCUS workflow that is adapted to the high clinical volumes faced by internists | Workflow |
Lack of quality safeguards | Establish a quality and patient safety program | Patient safety |
Lack of evidence | Generate local data on clinical effectiveness, efficiency, and relevance of POCUS | Research |
Lack of sustained efforts | Build capacity within the division and foster strong interdepartmental collaboration | Sustainability |
Plan program resources, activities, and outputs
Resources/Inputs | Activities | Outputs | Pillars |
---|---|---|---|
Early adopters1 Infrastructure: 1. Ultrasound machines on wheels on medical wards 2. Hand held devices that allow for portability 3. Archiving capabilities Funding: 1. POCUS leads -Protected teaching, administrative and research time 2. Non-clinical partners -Biomedical engineering department -Information system department 3. Academic grants to support research, quality improvement and innovation | POCUS academic half days | Establish a POCUS curriculum imbedded within the GIM residency training program | Education |
POCUS rotation | |||
Asynchronous feedback on archived scans | |||
GIM POCUS rounds | Continuous professional development for practicing attendings | ||
POCUS course (interdepartmental) | |||
Bedside scanning sessions | |||
Optimize the physical location of US machines | Optimize the physical environment | Workflow | |
Optimize the US to user ratio | |||
Integrate an archiving platform with US machines and the hospital information system | Onboard users to an archiving platform | ||
Training sessions on the use of the archiving platform | |||
Establish a system failure reporting process for US machines and the archiving platform | Maintenance of infrastructure | ||
Establish standards for what constitutes an adequate scan2 | Quality assurance of scans | Patient safety | |
Establish and implement a credentialing process3 | |||
Establish a mechanism by which a proportion of scans performed by credentialed users are reviewed | |||
Adopt patient safety policies4 | POCUS quality improvement program | ||
Conduct morbidity and mortality rounds for POCUS-related adverse events | |||
Implement an adverse event reporting and reviewing process | |||
Develop questions and set up projects that are specific to the use of POCUS in GIM | Research program with a focus on quality improvement and implementation science | Research | |
Develop an IM POCUS fellowship | Capacity building | Sustainability | |
Recruit and retain credentialed users | |||
Interdepartmental rounds | Cross-departmental collaboration | ||
Interdepartmental delivery of teaching activities (course, academic half days) |
Monitor
Pillar | Indicator | Frequency |
---|---|---|
Education | # of credentialed GIM trainees | Annually |
# of credentialed GIM attendings | Annually | |
Workflow | # of archived scans by credentialed users | Quarterly |
# of system failures reported to IS and biomed | Quarterly | |
Level of agreement with “Our POCUS infrastructure (machines and archiving) facilitates the safe use of POCUS in patient care” | Annually | |
Patient safety | % of scans performed by credentialed users that meet quality assurance standards | Quarterly |
# of reported POCUS-related adverse events | Quarterly | |
Research | # POCUS publications with GIM as principal investigator | Annually |
# POCUS grants with GIM as principal investigator | Annually | |
Sustainability | # of POCUS-fellowship trained internists in the division | Annually |
# of credentialed internists participating in the delivery of the training program | Annually | |
# of non-internists participating in the delivery of the training program | Annually |