Perspectives on Point-of-Care Ultrasonography Credentialing and Privileging: A Qualitative Study.

Abstract

Point-of-care ultrasonography (POCUS) use is rapidly expanding across several acute care specialties, yet no defined standards currently exist to guide health systems in regulation of POCUS use or clinician best practices. To describe existing POCUS credentialing and privileging policy design and implementation in a purposive sample of health care institutions across the US. This qualitative study used a cross-sectional, mixed-methods analysis of POCUS policies and procedures conducted between July 23 and October 28, 2024, and was guided by the Practical, Robust Implementation and Sustainability Model (PRISM) framework. Qualitative analyses used an interpretive phenomenological approach. Participants were POCUS leaders at health care institutions with existing POCUS policies, representing diverse geographic areas, sizes, and practice settings. Thirty-item online survey and 60-minute key informant structured interviews. Quantitative survey findings and qualitative analyses of current POCUS policies and practice patterns related to content, implementation, adoption, facilitators, and barriers to use. Twenty survey and interview participants were included (mean [SD] age, 41.17 [3.79] years; 15 [75.0%] male) and 19 POCUS policies were analyzed. Interviewees reported that successful policy development was influenced by contextual factors (eg, institutional motivators, external forces), policy infrastructure, diverse stakeholder engagement, ability to anticipate and address multilevel barriers, and strategies to maximize policy reach, adoption, and sustainability. Key insights from interviewees highlighted the importance of multidisciplinary POCUS committees and purposeful policy design tailored to align with institutional POCUS practice patterns and values. Leaders stressed the need for careful consideration of policy outcomes and institutional capabilities prior to implementation. While features of policies varied, most delineated specific POCUS applications within the policy and all required institutional training or proctoring from institutional POCUS champions. This study identified common themes and barriers in POCUS implementation and strategies used by exemplar institutions to aid other programs in addressing POCUS privileging and establishing standards for safe and effective POCUS use in patient care. The findings suggest POCUS policy development is important for standardizing its use within institutions, guiding training requirements, and establishing oversight procedures.