Factors influencing the use of Point Of Care Ultrasound (POCUS) on adult patients by Accident and Emergency department (A&E) doctors in tertiary care hospitals in Colombo district, Sri Lanka; a descriptive cross-sectional study

Abstract

Introduction:Point of care ultrasound (PoCUS) is an essential component of A&E setting all over the world. It is used for diagnosis and assisting bedside procedures. Usage of PoCUS has been shown to improve quality of patient care. There are no formal studies in Sri Lankan A&E setting to assess level of its usage and the barriers of using it. This study aimed to assess these aspects among ED doctors in three tertiary care hospitals in Colombo district. Methodology:This descriptive study was conducted by self-administered questionnaires distributed among 72 ED doctors working in the above setting. Questionnaire consisted of questions related to sociodemographics, types of PoCUS performed, barriers to PoCUS use etc. Ability to perform PoCUS was assessed by Likert grading from 1 to 5 based on operator’s own opinion. Statistical analysis was done using SPSS. Results- All the tertiary care emergency services had access to an ultrasound machine. PoCUS has been used for a wide variety of bedside scans and therapeutic procedures. Majority has been used to detect free fluid in peritoneal cavity (66.6%) and FAST scans (65.3%). Post graduate doctors (PG) were more confident in configuring PoCUS machine for procedures than non PG doctors (82.8% vs 5.4%). Ability to perform PoCUS was associated with post graduate exposure, >1 year of experience using it and doing >300 procedures in last 3 months (p=0.001). Main barriers identified for PoCUS usage were lack of training and lack of quality ultrasound machine. Discussion: Though PoCUS is mainly performed by PG doctors, important scans such as FAST, intra peritoneal free fluid assessment are done by non-PG doctors too. Compared to similar international studies, less number of latter doctors were capable of doing PoCUS in Sri Lanka. Empowering these doctors with PoCUS skills will improve the sustainably of this service in emergency care setup as they work in units for longer duration. A study where candidates’ skills are assessed by a third party would have provided more accurate reflection of PoCUS usage. Conclusion: Embracing updated technology and further improvement and availability of PoCUS training among ED doctors will enhance sustainable emergency patient care in Sri Lanka.