A Beginner’s Guide to POCUS
July 28, 2021
Over the past few decades, the healthcare delivery landscape in the United States has evolved in some amazing ways, making timely and effective diagnoses more readily available and accessible to the population.
One drawback for patients who rely on these facilities emerges when they need advanced imaging—like an ultrasound—and have to be sent to another location to have that scan performed. Point-of-care ultrasound—POCUS—helps to mitigate the factors that prevent some patients from seeking treatment, accessibility barriers like time, money, or the travel required to make (and keep) ultrasound appointments.
In a 2020 article, the Annals of Translational Medicine identified point-of-care ultrasound (POCUS) as “the next evolution of medical education.” In this article, we’re taking a closer look at POCUS technology and what it means for current and future patients. We’ll answer the following questions:
- What Is point-of-care ultrasound, or POCUS?
- Why is POCUS important? What are its advantages and benefits?
- What is POCUS used for?
- What are POCUS ultrasound guidelines? How can I learn POCUS?
What Does POCUS Mean in Medical Terms?
To put it simply, POCUS is ultrasound technology at the point of patient care. This means performing an ultrasound examination wherever the patient has gone for treatment, rather than transporting the patient to a different location (within the facility, or elsewhere) where an exam can be scheduled and completed. POCUS greatly expedites the entire diagnosis-through-treatment process in order to take action and arrive at crucial patient outcomes.
What Is a POCUS Exam?
POCUS is quick, non-invasive, and increasingly available throughout the country. It relies on portable, compact transducer devices that can pair with smartphones or tablets to create high-resolution, real-time images that can be viewed and interpreted within moments, all within the examination room.
Compared with the more comprehensive ultrasound technology most people are familiar with, POCUS is well-suited for answering very specific questions to diagnose—or rule out—suspected conditions. In addition, it can be a good tool for procedural support such as needle guidance.
Why Is Point-of-Care Ultrasound Important?
POCUS is important because it bridges the all-important gap between a routine-type physical examination and more advanced (and costly) imaging technologies like CT or MRI scans. In other cases, it’s bridging the gap between a patient’s ER or urgent care visit and what may be a vital diagnostic scan. Further, POCUS improves processes and outcomes for patients, as well as physicians and other medical professionals and facilities. It can provide quick, accurate diagnoses in order to determine the best treatment(s).
What Are the Advantages of POCUS?
“In 20 years, a pocket ultrasound device may be as ubiquitous for physicians as a stethoscope is today,” the American Academy of Family Physicians (AAFP) has noted. It’s no wonder, once you start to unpack the advantages of POCUS over conventional, stationary ultrasound technology. “While conventional methods of physical examination and other diagnostic procedures and tools are of critical importance, healthcare professionals who use POCUS in their clinical practices have become more accurate and empowered,” POCUS.org has said.
Among the most compelling point-of-care ultrasound benefits are:
- It’s portable: Not only is POCUS more affordable than conventional ultrasound machines, but it’s also much more convenient due to its portability. When a hospital supplements existing ultrasound technology with POCUS, it raises the bar on the standard of care they can provide.
- It’s affordable: POCUS provides an accurate diagnosis at a more cost-effective price point than standard machines. Compare the POCUS ultrasound price—as little as $2,000—with that of a standard ultrasound machine, which can cost around 15 times as much.
- It’s safe: Unlike conventional ultrasound or X-rays, with POCUS there is no risk of ionizing radiation.
- It’s quick: It only takes a few minutes to perform a POCUS scan and begin interpreting the results.
- It complements radiology: When used in conjunction with other radiology services, POCUS empowers physicians and other healthcare professionals to make better diagnostic decisions based on a fuller picture of patient health.
- It complements physical exams, too: POCUS providers can view exam results, virtually in real-time, to help confirm or rule out specific diagnoses suggested by the physical examination.
- It’s appropriate for sensitive situations or unconscious individuals: Sometimes patients are simply not in any condition to be transported within a facility or to another location altogether for medical imaging—not to mention the delay involved in scheduling and administering an ultrasound. With POCUS, the patient can remain in their room, helping to protect the patient, medical staff, and other individuals from unnecessary exposure to contagious illness, for example.
- It facilitates a more personal experience: With POCUS, the treating physician or other healthcare professional is able to perform a scan and communicate the results without needing to leave the examination room. This not only simplifies and streamlines the process, but it also gives patients a less stressful experience.
What Is POCUS Used For?
The range of potential use cases for POCUS is growing, and it’s expected to only continue growing as new innovations develop. As POCUS stands now, we can categorize its use cases into four general categories, each of which we’ll be taking a closer look at in this section:
- Diagnostic uses
- Emergency department applications
- Procedural guidance
- Improved workflows for ordering, conducting, and documenting examinations
What Can POCUS Diagnose?
POCUS is effective in aiding or providing outright diagnoses across a number of outpatient, inpatient, and urgent care settings. Consistent evidence supports the use of POCUS as an effective practice to augment or complement a clinical exam, without requiring unnecessary radiation exposure to the patient. Some common use-cases include the following, as outlined by American Academy of Family Physicians (AAFP) research:
- Abdominal Aortic Aneurysm (AAA): This screening practice “reduces aneurysm rupture mortality by 34%” and yields “100% sensitivity and specificity for AAA screening with POCUS in primary care.” Further, AAFP’s research found that emergency department POCUS applications “demonstrated 99% sensitivity and 98% specificity” in AAA diagnosis. Impressively, too, after just three hours of POCUS training, a medical student was able to identify “15 of 16 aneurysms in 57 patients.”
- Deep Venous Thrombosis (DVT): For this condition, “emergency department POCUS of common femoral and popliteal veins have 96% sensitivity and 97% specificity for detecting DVT.” Again, only a handful of training hours are needed to effectively conduct a POCUS exam and interpret its results—after just two hours of training, “primary care physicians diagnosed DVT with 90% sensitivity and and 97% specificity.”
- The Cause of Respiratory Distress: When POCUS findings combine with clinical evaluation, it helps differentiate cardiac and pulmonary causes of respiratory distress. POCUS can even help diagnose related to symptoms like pneumonia or bronchial obstruction. Again, POCUS proves to be effective and accurate—in fact, it’s “more sensitive than plain radiology in diagnosing [conditions] like pleural effusion (94% sensitivity) and pulmonary contusion (92% sensitivity).” Additionally, compared with standard radiology practices, when applied to lung exams, POCUS “decreases emergency department diagnostic time by two hours.”
- Skin and Soft Tissue Infections: POCUS provides timely and accurate diagnoses of various skin and soft tissue infections, and specifically differentiate the presence or absence of a soft tissue abscess. Clinical examinations (without medical imaging) “can be incorrect in up to 22% of cases” which means a delay in accurate diagnoses and treatment. It also “decreases inappropriate incision and drainage of cellulitis without abscess by up to 20%” vs. clinical exams alone. While CT imaging provides 77% sensitivity for diagnosing abscess, that figure is 86% with POCUS.
Additional diagnostic possibilities supported by “moderate” evidence in the study include:
- Biliary Colic and Cholecystitis
- Bowel Obstruction and Perforation
- Decreased Cardiac Ejection Fraction and Presence of Pericardial Effusion
- Elevated Intracranial Pressure
- Intraperitoneal Bleeding in Trauma
- Obstetric and Gynecologic Conditions (such as Ectopic Pregnancy)
- Hydronephrosis (caused by Renal Colic)
- Retinal Detachment
Point-of-Care Ultrasound in the Emergency Department
One of the most compelling use-cases for the application of POCUS is in the improvement of emergency medicine—primarily, in providing more rapid diagnoses while minimizing inconvenience to the patient. A recent Annals of Medicine and Surgery study discusses how “POCUS has been used to aid the diagnosis of multiple medical conditions ranging from acute appendicitis, airway compromise, abdominal aortic aneurysm, traumatic injury assessment” and more.
In cases like these, sending the patient to another office or facility or setting up a future appointment can delay diagnosis and create added stress for the patient. Too often, the effort required results in patient no-shows, unfortunately. In addition to the time- and cost-saving advantages, another major advantage of integrating POCUS into daily clinical practice is the streamlined ability to integrate findings with clinical examination results and patient history.
Using POCUS for Procedural Guidance
Another category of POCUS applications is procedural guidance, a usage that is becoming more normalized as standard practice. According to the American Academy of Family Physicians (AAFP), for example, POCUS imaging “reduces complications, arterial puncture, and time to completion” of central venous catheter placement. Among other things, POCUS also:
- “Reduces the rate of dry taps” when conducting thoracentesis and paracentesis.
- “Reduces bleeding and prevents failure in paracentesis.”
- “Reduces traumatic lumbar puncture.”
Other routine-type procedures made easier with POCUS imaging include biopsies, IUD placement, needle insertion, and more.
Improving Workflow for POCUS
For decades, hospitals and other facilities have had to deal with costly ultrasound machines and the cumbersome workflows they entail. This is largely due to the disadvantages of the conventional (stationary) ultrasound machines, and order-based workflow processes that haven’t evolved over time to meet patient needs in the modern age. The result is that many patients experience delays between having a scan ordered and then performed. That’s valuable time that can be saved when integrating POCUS capabilities.
In an encounter-based workflow process, there’s no need to schedule scans for a future time or date, in a totally different location. Because POCUS devices are portable and easy to learn to use, more healthcare workers can be trained to scan patients, but this puts pressure on evolving the existing ultrasound workflow to meet new demands as they arise.
As an added benefit for physicians and other medical professionals and the facilities they work in, POCUS can streamline post-scan documentation. This is crucial, as all too often, ultrasound results are either delayed in their documentation or go incompletely documented—a compromise that can be costly from a legal and ethical standpoint.
How Exo Works™ Simplifies the POCUS Workflow
Here’s how Exo’s point-of-care ultrasound workflow solution, Exo Works™, intelligently and intuitively enables the entire POCUS workflow, from scanning to billing in literally minutes:
- Scan the patient with any DICOM-enabled ultrasound machine.
- Review and document your findings in seconds.
- Automatically save to EMR and PACS for accurate billing and secure storage.
- Securely distribute and access exam results remotely.
What Are POCUS Ultrasound Guidelines?
In an attempt to provide clear and unified guidance for providers who perform (or may perform) point-of-care ultrasound exams, the Society of Point of Care Ultrasound has published exhaustive guidelines to follow. It consists of 14 sections:
- Section 1: Establishes the purpose of publishing and standardizing these guidelines.
- Section 2: Outlines the evolution of ultrasound technologies and their applications, and how POCUS is becoming more widely implemented (and therefore benefits from clear guidance and best practices).
- Section 3: Defines the full scope of clinical ultrasound in examining patients, diagnosing (or ruling out) certain conditions, or helping to guide certain procedures. This section also breaks down the difference between comprehensive/consultive ultrasound and clinical ultrasound.
- Section 4: Outlines the core components that should define POCUS competency. These include knowledge related to indications for the exam, image acquisition and interpretation, and the integration of POCUS findings into overall patient management. These competencies serve to ensure that diagnoses are accurate and well-supported. This section also lays out a two-phased approach to competency-based training—which begins with introductory training, then proceeds to a proctored scanning phase where knowledge is put into practice.
- Section 5: Describes how and why common training and proficiency standards—including formal certification—need to be developed and implemented. Among the essential topics or competencies that should be covered include image acquisition, image interpretation, and clinical integration of POCUS findings.
- Section 6: Outlines exactly how healthcare professionals can attain the required competencies for accurate and effective POCUS-enhanced examination. This begins with acquiring basic knowledge, and also includes a “proctored” period in which every POCUS exam should be evaluated through quality assurance to ensure consistent accuracy.
- Section 7: Helps organizations or facilities to create a “clearly defined model of practice” based on static and dynamic variables. Static variables include state and local laws, medical specialties, and patient populations. Unlike static variables, dynamic variables are usually within the provider’s control and include examples like a physician or clinician’s experience and skill, institutional culture, equipment and other resources and capabilities, individual patient conditions, and more.
- Section 8: Focuses on skill sustainment to maintain proficiency beyond the training and proctored phases discussed in Sections 6 and 7.
- Section 9: Explores topics of leadership and advocacy around POCUS. In other words, “a structured program with designated leadership is needed to drive the process, ensure quality review, mentor participants, and promote education.” This doesn’t just refer to the adoption of POCUS and related methodologies, either; it also relates to the support services and quality assurance aspects of POCUS.
- Section 10: Provides a closer examination of quality assurance and improvement considerations, as a means of ensuring continued and consistent POCUS success in interpretation and diagnosis.
- Section 11: Discusses high-level points around the value and safety of clinical ultrasound, including incidental findings.
- Section 12: Covers POCUS-related documentation requirements, including documentation of a scan’s medical necessity, written interpretive reports, and image capture.
- Section 13: States that “diagnostic and procedural ultrasound performed by clinicians should be coded and reimbursed in the same manner as any other procedure which is performed in the course of the patient’s care.” This approach provides a standardized language and process for applying and modifying Current Procedure Terminology (CPT) codes. These codes are not only used by medical facilities and healthcare providers, but they’re also used by insurance companies as well as Medicare and Medicaid in their reimbursement practices.
- Section 14: Offers concluding thoughts and a list of references for further study.
How Can I Learn POCUS?
Here, we’ve collected a variety of resources for learning more about POCUS and its uses, how to enroll in POCUS courses or obtain certifications, evaluate buying considerations, and learn about how our Exo Works solution is changing the game.
Learn More About POCUS and Its Uses
This comprehensive guide, Point-of-Care Ultrasound: A Practical Guide for Primary Care, was put together and published in the American Academy of Family Physicians (AAFP)’s peer-reviewed Family Practice Management journal.
You can find additional information about emergency room applications for POCUS in the following sources:
- American College of Emergency Physicians (ACEP)’s emergency ultrasound resources.
- The POCUS Atlas, a hub for global point-of-care ultrasound education content.
- Core Ultrasound, home to a library of “5 Minute Sono” video walkthroughs.
- Highland Ultrasound, provider of online education around emergency ultrasound.
This online article, POCUS: A Small Tool With Big Benefits for Primary Care, focuses on specific use cases that illustrate the important benefits of POCUS, from the point of view of a primary care physician.
This “Point-of-Care Ultrasonography” research study, published in American Family Physician, provides a wealth of information and statistics around the effectiveness of POCUS across a number of applications. If you’re looking for granular details to support the use of POCUS, this is a fantastic place to start.
If you’re looking for a POCUS online course to familiarize yourself with the basics in a more interactive format, POCUS 101’s website is a great place to start. True to its name, their website is home to easily-digestible information, with step-by-step guides with titles like:
- RUSH Exam Ultrasound Protocol: Step-By-Step Guide
- Cardiac Ultrasound (Echocardiography) Made Easy: Step-By-Step Guide
- Abdominal Ultrasound Made Easy: Step-By-Step Guide
- Obstetric/OB Ultrasound Made Easy: Step-By-Step Guide
If you’d prefer to try a free POCUS course instead, here’s a List of Free Online Ultrasound Courses put together by BestAccreditedColleges.org.
The American College of Physicians have an online portal where you can find a number of learning activities related to point-of-care ultrasound in internal medicine, including online, self-paced modules based on common POCUS applications and live, virtual courses for physicians.
Finally, for the convenience of on-the-go, easily-referenceable information about all things POCUS, there’s the Pocket Guide to POCUS. You can order a copy from Amazon or directly from the publisher. Or, you can use this link to read and search the Pocket Guide to POCUS in PDF (digital) format.
Get POCUS Certified
According to one survey, 84% of physicians see the need for POCUS certification. POCUS.org is the online home of the Point-of-Care Ultrasound Certification AcademyTM. The POCUS Certification Academy exists to advance the standards in point-of-care ultrasound methods and applications. On their website, you can view their certification offerings or browse resources for more specialized education and training.
They’ve outlined a progression of learning outcomes that starts with earning a POCUS Fundamentals Certificate ($125 at the time of this writing). Succeeding with the two-part assessment is the prerequisite for earning additional or advanced certificates. Click the link above to view certification details, or view the curricular outline here.
Through further coursework, individual clinical or specialty POCUS certificates can be obtained ($150/each). Individual clinical offerings center around areas like cardiac, gastrointestinal, and obstetrics applications. Their specialty offerings ($625/each) cover certifications like POCUS Generalist, POCUS Emergency Medicine, POCUS Musculoskeletal, and Global POCUS Principles.
When it’s time to make the case for your medical facility to invest in POCUS technology and training, one place to start is by reviewing the many benefits of point-of-care ultrasound. Covered earlier in this article, you can find more here. To make the case for POCUS adoption to stakeholders, frame the benefits within the context of your current practice’s details—including areas of focus, patient population, current technological capabilities, staffing, workflow, and so on. Where are the main areas you see your patients benefiting from quicker, more convenient diagnoses—meaning quicker and more effective treatments? What are the pain points that impact healthcare providers and their patients?
As discussed earlier, one of the biggest challenges of conventional ultrasound is that they rely on a large, expensive machine in a fixed location. Patients who need imaging often must be scheduled at a facility other than where they’re having a clinical visit, and then they are usually accommodated in the order scheduled. For some patients, this means a long wait—during which time, their anxiety can grow while conditions potentially worsen. POCUS facilitates encounter-based examination for the scenarios that need it, such as in emergency medicine where time is of the essence.
Learn More about Exo, and See How Exo Works Works
One of our goals at Exo is to empower healthcare providers to spend more time—and more quality time—with their patients. We understand the vital importance of timely diagnosis as a precursor to making treatment recommendations and getting patients well again.
At its core, POCUS technology is all about streamlining ultrasound processes for improved outcomes for everyone involved. We developed Exo Works™ to accommodate better, more efficient workflows, from the initial ultrasound order through the next steps to address and treat whatever medical imaging reveals. Whether POCUS is being used in an order-based or encounter-based workflow, our solution makes it easy.
In addition to elevating the standard of patient care, Exo Works also helps consolidate and simplify documentation, reporting, billing, and reimbursement for POCUS exams.
Exo is a health information and devices company modernizing medical imaging starting with making ultrasound simple and affordable for all. Exo just released Exo Works™, an intelligent and intuitive point-of-care ultrasound workflow solution that lets medical practitioners document exams in seconds and easily manage QA from anywhere. Learn more about Exo Works.