What Is POCUS Quality Assurance?

Point-of-Care Ultrasound (POCUS) quality assurance, or sometimes called POCUS QA, refers to both the workflow and feedback process that experienced professionals do to ensure that all ultrasound users are adequately capturing images and using the POCUS device(s) correctly. Having ultrasound scans regularly reviewed helps care providers use ultrasound with increased diagnostic evidence. But this crucial step can’t happen if there isn’t an easy way to easily share ultrasound scans and resulting interventions with one another. Documenting ultrasounds is essential for patient outcomes, as well as the patient continuum of care, but this quality assurance step requires time, effort, and energy that many healthcare providers just don’t have. Even when documentation is done, the POCUS program director does not have time to review each patient’s medical record to find scans by each user.

So, is the answer to avoid doing POCUS quality assurance? Of course not. But it does present a challenging situation that many emergency departments must grapple with. The best POCUS quality assurance program removes complexity instead of adding to it. Here’s some insight on how to change the narrative and simplify POCUS in your hospital, from the bedside to the billing department.

Is POCUS the Standard of Care?

Point-of-care ultrasound performed at the bedside has become standard practice in obstetrics, musculoskeletal medicine, and in the emergency department, according to a 2020 article in American Family Physician. Though handheld POCUS devices have become more commonplace in these and other clinical settings, the actual standards of care and best practices are not always clearly defined. For instance, POCUS’ diagnostic accuracy of skin and soft tissue infections in the emergency setting is just one use case that is being considered in hospitals.

Whether or not a doctor should use a POCUS device, magnetic resonance imaging, or other imaging modality depends on the patient’s symptoms, condition, and urgency of the situation, among other factors. This is why it is generally recommended that each hospital system or program develops their own standards of care and policies surrounding POCUS, which all staff can be trained to perform. With that said, the Society of Point of Care Ultrasound (SPOCUS) has established clear and unified guidelines for training any health providers performing clinical ultrasound at the point-of-care.

Once it’s clear how POCUS can and must be used in your clinical setting, the time has come to implement the program and perform quality assurance to ensure it’s achieving the right outcomes for patients and the hospital. You might call it “Pocus 101.”

POCUS 101: How Can Hospitals Implement Point-of-Care Ultrasound?

Point-of-care ultrasound machine quality assurance must support groups of doctors and associates in maintaining four key areas of competence using POCUS devices:

1. Identifying indications for the exam
2. Image acquisition
3. Image interpretation
4. Applying findings in patient care

Each hospital implementing the use of POCUS devices should name a POCUS program director, typically a physician on the staff of the emergency department. This individual is tasked with making sure the POCUS program runs smoothly from the point-of-care all the way to billing handoff and revenue capture. The program director’s duties include refreshing equipment and other tools as needed, and bringing new POCUS users on board with the hospital standards. They also must regularly perform quality assurance to confirm that all parties are using point-of-care ultrasound correctly and effectively.

POCUS quality assurance means a performing a recurring review of a certain percentage of the POCUS exams being conducted in the department. It will be impossible for the program director to review every scan that is performed. Instead, the POCUS program director or another qualified professional might take time every few weeks to review 10-15% of each users’ exams and provide feedback. This is important for both the hospital and the users.

• For the hospital, it is a way of confirming alignment with best practices among all physicians. This includes everything from when the team is supposed to use POCUS to how the exams are being documented in EMR.
• For the users, it is valuable to receive feedback on the quality of the images acquired, how the images are interpreted, and how the findings are applied to patient care. Specifically, the program director might give feedback on the images captured, how they were used to inform the diagnosis and care plan, and what might have gone differently.

What you might be picturing right now is one physician sorting through tons of patient records, making manual notes, and spending a lot of time in meetings with each POCUS user. But this does not have to be the reality thanks to modern solutions in the market. Since the POCUS program director is also working as a full-time physician, they have a vested interest in pursuing solutions that make life easier for all POCUS users in the department. Here’s a look at some of the current best practices in ultrasound workflow management, including for POCUS.

POCUS Emergency Medicine Workflow

Once an emergency department physician has decided to use POCUS as a diagnostic or procedural tool, the scans are conducted using a portable ultrasound machine. This might be a cart-based solution that moves from bedside to bedside, or a handheld device connected to a phone or tablet. Increasingly, hospitals are encouraged to provide cloud-connected devices for physicians instead of having them use their own phones or tablet.

There is historically a large gap between the point where emergency ultrasound images are acquired and the patient’s medical record. This gap is what makes the quality assurance we described above such a challenging suggestion for many emergency departments, especially those with no POCUS workflow in place at all. Many ultrasounds are performed without any reimbursement in an emergency setting, simply because the physicians don’t have time to go back later and manually upload images to chart the ultrasound. Instead, they simply document the bare essentials, such as the diagnosis that resulted from the ultrasound and the plan for care moving forward.

This gap in documentation represents legal liability as well as lost revenue. If the hospital cannot demonstrate a record of the ultrasound, this may lead to risks later in the patient’s care. Will the physician be able to fully justify their diagnosis and resulting treatment without the POCUS images included in the medical record? And, how can the POCUS program director remain informed of the quality of scans? It is essential that POCUS workflows include documentation and quality assurance for the benefits of this technology to be fully realized for all stakeholders.

Failing to document need-based ultrasounds also means doctors have to see more patients to close the gap in revenue for services that are provided but not billed for. At both ends, whether it’s using lengthy manual processes or avoiding the process altogether, the result has historically been more work for physicians. Exo has made it our mission to leverage technology against these barriers and make ultrasound easier for all. We make documentation and quality assurance a natural result of the POCUS exam itself, starting the moment it is performed.

How Can POCUS SaaS Improve Quality Assurance and Manage Risks?

Exo Works™ is a prime example of how POCUS software-as-a-service (SaaS) can transform ER operations. POCUS SaaS makes it easier to monitor quality, give feedback, and document exams for accurate billing and patient recordkeeping. Here’s a snapshot of how it works:

• A clinician can scan a patient with any DICOM-enabled ultrasound machine and use Exo Works to document a POCUS exam and transmit that documentation to the EMR system.
• Findings are reviewed and documented in seconds thanks to ready-made templates, and can even be sent to other members of the care team. Practitioners can tag exams as “clinical” or “educational” so there is no confusion, just clear material for feedback–and documentation for compliance.
• When an exam is mis-assigned or other human error occurs, doctors can fix it themselves with a few simple clicks.

With a tool like Exo Works in place, the POCUS program director can also perform quality assurance with a few simple clicks. They will be able to see the scans each user has performed, and provide written comments and feedback directly within the tool. This saves everyone time while also improving performance.

Ultimately, Exo Works puts clinicians in the drivers’ seats of their own POCUS programs, without the need for hyper-reliance on IT to get the work done. The streamlined communication and simplicity carry through to the billing department.

Ultrasound Billing Guidelines

Standards established by organizations like the American College of Radiology (ACR) and American College of Emergency Physicians (ACEP) define what needs to be documented so an ultrasound can be billed. Both private insurers and Center for Medicare and Medicaid (CMS) guidelines for billing ultrasounds require documentation such as:

• Demographic information about both the user and the patient
• Exam findings and interpretation
• All images resulting from the ultrasound
• Proof of quality assurance processes

This data will be required to bill any ultrasound, but POCUS presents unique challenges in terms of workflow that creates barriers to the easy collection of this data. The Exo Works platform is deliberately created to collect all the information necessary for great patient care, effective POCUS quality assurance, and insurance billing that results in claims being paid out, not denied or re-coded.

Request a demo of our product to see if Exo Works is for you.