Interventions to increase point-of-care ultrasound use in a pediatric emergency department

Objective We sought to determine which interventions have effectively increased point-of-care ultrasound (US) use in a pediatric emergency department (ED). Design/Methods We evaluated the impact of specific interventions conducted over a 5-year period (2010-2015) on point-of-care US performance in a tertiary care pediatric ED. Ultrasound use by attending physicians and fellows was ascertained from a departmental database. Interventions assessed included the following: (1) initiation of an US fellowship, (2) acquisition of a second US machine, (3) performance of an US-related research project in the department, (4) initiation of faculty US curriculum, (5) earlier introduction of US education for pediatric emergency medicine fellows, and (6) administrative mandate dictating faculty requirements for credentialing. Mean monthly US use was trended over time using statistical process control methodology, and the impact of major interventions was analyzed using interrupted time-series analyses. Results The mean number of US scans increased from 2.0 to 5.9 per attending per month and from 4.3 to 7.1 per fellow per month over the study period. Using interrupted time-series analyses, we observed the only intervention to significantly increase attending US utilization was an administrative credentialing mandate, with an associated increase of 6% per month (incidence rate ratio, 1.06; 95% confidence interval, 1.01-1.11). Conclusions Point-of-care US use has increased over time for both fellows and attending physicians. We observed that an administrative mandate led to a significant increase in US use among attending physicians.