Medical practitioners use point-of-care ultrasound (POCUS) in many settings and scenarios, especially where treating patients at the point of care is essential. General practitioners and family medicine providers can also use POCUS, sparing their patients a visit to a hospital or outpatient center for imaging. POCUS uses have become especially common—and appreciated—in specialties like obstetrics, cardiology, pulmonology, and the emergency department. Let’s talk more about what POCUS exams reveal and how care providers are trained and certified to perform them.

What Is a POCUS Exam?

A POCUS exam is an ultrasound performed at the point of care. This could be the emergency room, a patient’s bedside, or any other clinical setting. The images produced by the ultrasound will be generated in real-time through the screen of a smartphone or tablet connected to the POCUS device. There are three main types of POCUS exams: diagnostic, procedural, and examinatory.

• Diagnostic POCUS exams help care providers narrow their focus to guide treatment and specialist referrals. POCUS exams can be used to diagnose cardiac conditions, lung conditions, internal bleeding and blood clots, among many other conditions, or to pinpoint the causes of generic symptoms like abdominal pain.
• Procedural POCUS exams can be performed in conjunction with another procedure, such as to guide a needle during a biopsy or to find a foreign body during surgery.
• Examinatory POCUS may be performed as an extension of a physical exam, such as to examine if a lump is solid or cystic, or determine if a baby has turned head-down in utero.

While a POCUS exam may not be fitting in each case, overall this technology reduces the time to diagnosis and so allows patients to experience better outcomes. POCUS also allows clinicians the insights of an ultrasound during times or in locations where a referral to radiology is not an option.

Point of Care Ultrasound Guidelines

Point-of-care ultrasound guidelines are still emerging along with this technology. The Society of Point of Care Ultrasound (SPOCUS) has shared guidelines for POCUS practice, including recommendations against outside accreditation through something like a point-of-care ultrasound course. Basically, each university training program and/or health system should manage and oversee the accreditation and certification of their own students/employees. SPOCUS does not recommend using outsourced providers to gain this accreditation. “Outsourcing governance of a clinician’s professional role or capacity to external certification bodies can be tantamount to surrendering the right to professional self-determination, and abdicating the professional responsibility to act as an advocate for what is best for patients and clinical practice,” the organization writes.

Instead, SPOCUS encourages a competency-based approach to POCUS training within each organization. This method more likely ensures that learners have acquired the knowledge and skills to successfully use POCUS the way it works best in that organization’s workflow and culture. Competency can be broken down into four main areas:

1. Knowledge related to indications for the exam—does the practitioner know when to use POCUS?
2. Image acquisition—can the practitioner gain an adequate image through POCUS?
3. Image interpretation—are the images generated by a POCUS exam interpreted correctly?
4. Integration of findings into patient management—how are the findings of the exam applied?

To develop these competencies, SPOCUS recommends a minimum amount of practice for caregivers: 150-300 general scans and 25-50 additional scans unique to each relevant proficiency (pulmonology, obstetrics, etc.). This credentialing should take place within the local hospital or clinic credentialing policies. Further, it’s advised that at least 5% of these exams should demonstrate pathology. After initial credentialing, practitioners should be observed during their first 10 or so POCUS exams as an additional quality assurance measure.

Keep in mind that these guidelines are subjective. Static variables such as the doctor’s specialty and laws in their state, and dynamic variables like the availability of equipment and organizational culture, can all inform how each practice or institution defines their own POCUS guidelines. Read SPOCUS’s full point-of-care ultrasound guidelines to learn more.

Is Point of Care Ultrasound Billable? Exo Works™ Makes it Easy!

Point-of-care ultrasound is billable like any other ultrasound. In fact, a desire to accurately bill and receive compensation for all ultrasound services is one reason some health systems are adopting an improved POCUS workflow. Exo Works, Exo’s POCUS workflow solution, makes ultrasounds easier to document and bill than ever before. Here are some of the features of Exo Works:

• Automatically save ultrasounds to patient electronic medical records (EMR) or clinical picture archiving and communication systems (PACS)
• Easily update the patient, exam type, and worksheet with just a few taps, minimizing the rework to correct potential billing errors
• Built-in credentialing tracking, quality assurance, and collaboration space
• Epic App Orchard Certified and Cerner CODE Program approved

Exo Works makes it easy to implement, monitor, improve, and scale your POCUS program without needing to call on IT every time there’s a challenge. Schedule a demo today and learn more about how Exo Works can help your institution maximize the benefits of POCUS.