title: Access to and Use of Point-of-Care Ultrasound in the Emergency Department.
abstract: BACKGROUND
  Growing evidence supports emergency physician (EP)-performed point-of-care ultrasound (PoC US). However, there is a utilization gap between academic emergency departments (ED) and other emergency settings. We elucidated barriers to PoC US use in a multistate sample of predominantly non-academic EDs to inform future strategies to increase PoC US utilization, particularly in non-academic centers.
  
  
  METHODS
  In 2010, we surveyed ED directors in five states (Arkansas, Hawaii, Minnesota, Vermont, and Wyoming; n=242 EDs) about general ED characteristics. In four states we determined barriers to PoC US use, proportion of EPs using PoC US, use privileges, and whether EPs can bill for PoC US.
  
  
  RESULTS
  Response rates were >80% in each state. Overall, 47% of EDs reported PoC US availability. Availability varied by state, from 34% of EDs in Arkansas to 85% in Vermont. Availability was associated with higher ED visit volume, and percent of EPs who were board certified/board eligible in emergency medicine. The greatest barriers to use were limited training (70%), expense (39%), and limited need (perceived or real) (32%). When PoC US was used by EPs, 50% used it daily, 44% had privileges not requiring radiology confirmation, and 34% could bill separately for PoC US. Only 12% of EPs used it ≥80% of the time when placing central venous lines.
  
  
  CONCLUSIONS
  Only 47% of EDs in our five-state sample of predominantly non-academic EDs had PoC US immediately available. When available, the greatest barriers to use were limited training, expense, and limited need. Recent educational and technical advancements may help overcome these barriers.
authors.affiliation: Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Sanders
authors.affiliation: Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Vicki E
authors.initials: VE
authors.lastname: Noble
authors.affiliation: Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Raja
authors.affiliation: Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Ashley F
authors.initials: AF
authors.lastname: Sullivan
authors.affiliation: Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D001131:Arkansas; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006254:Hawaii; D006801:Humans; D008910:Minnesota; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014463:Ultrasonography / Q000379:methods* / Q000706:statistics & numerical data; D018084:Ultrasonography, Interventional / Q000379:methods / Q000706:statistics & numerical data; D014707:Vermont; D014959:Wyoming