On May 28, 2014, PEM POCUS leaders representing the major paediatric institutions in Canada and the United States gathered in Toronto, Ontario for an event called P2Lead or PEM POCUS Lead. Over the course of two days, these 46 PEM POCUS leaders participated in a series of orchestrated small and large group discussions. Crowd-sourced topics were formulated using pre-event surveys and focused on quality assurance, clinical workflow, intra-hospital collaboration, faculty engagement, competency in training, collaborative research logistics, group communication and near term priorities.
Participants were offered a venue to share their personal barriers and challenges, and to elicit the collective experience of the group. Solutions were suggested and explored with equal voice given to all leaders regardless of program maturity or size. The enthusiasm and optimism created by the event was evident in the feedback. Comments reflected the high value of this shared experience at both the individual and group level. As P2Lead concluded, the group decided to develop an organizational structure to support ongoing collaboration and to build a platform for community development. P2 was born.
P2 has evolved into the P2Network to serve as a platform for sharing expertise, building research collaborations and offering mentorship in paediatric point of care ultrasound in the information age of medicine. We are a growing community of physicians committed to spreading the clinical application of point of care ultrasound to paediatric emergency departments around the world. Browse our team profiles in our comprehensive directory, and see where our network fellowship programs are offered.
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The Basics
What is POCUS?
POCUS stands for ‘Point-of-Care Ultrasound’, and
- it is ultrasonography brought to the patient and performed by a health care provider in conjunction with the clinical examination in real time
- it allows goal-directed simplified problem-based assessments (generally qualitative and binomial; rather than quantitative and descriptive)
- it allows findings to be directly correlated with the patient’s presenting signs and symptoms
- it allows real-time dynamic image interpretation (rather than images recorded by a sonographer and interpreted later)
- it allows the provider to maintain expected workflow (time sensitive and repeatable)
- it allows images to be archived for clinical education research and quality assurance purposes.
What is PEM POCUS?
Paediatric Emergency Medicine Point-of-Care Ultrasound, or PEM POCUS, is the application of ultrasonography on children seen in emergency departments. POCUS redefines the clinical encounter for children presenting to the emergency department by enabling providers to make better decisions and deliver superior care. PEM POCUS continues to grow exponentially across the globe as a result of increasing accessibility to ultrasound technology, digital connectivity and focused educational initiatives.
Who uses POCUS?
POCUS is becoming a critical tool in resource limited settings as a result of its high clinical value, low cost and portability. Physicians around the world and across a spectrum of specialties rely on POCUS to deliver care to their patients.
- Anesthesia
- Cardiology
- Critical Care Medicine
- Dermatology
- Emergency Medicine
- General Surgery
- Gynecology
- Neonatology
- Neurosurgery
- Obstetrics
- Oncology
- Ophthalmology
- Orthopedics
- Pediatrics
- Respirology
- Rheumatology
- Sports Medicine
- Urology
The History
The American College of Emergency Physicians (ACEP) published a position statement supporting the performance of ultrasound by appropriately trained emergency physicians.
The American Medical Association passed Resolution 802 and policy H-230.960 “recommending hospitals’ [privileging] committees to follow specialty-specific guidelines for credentialing decisions related to ultrasound by the physicians.”
The Accreditation Council for Graduate Medical Education (ACGME) mandated all emergency medicine residents attain competency in the use of point-of-care ultrasound.
The Canadian Association of Emergency Physicians (CAEP) published their first position statement, later revised in 2012 to reflect growing scope of practice.
A survey reported that 95% of emergency departments in North America with a pediatric emergency medicine fellowship program utilize point-of-care ultrasound in some manner, and 88% of programs provide training in point-of-care ultrasound for their fellows.
The American Academy of Pediatrics (AAP) released a Technical Report and Policy Statement for Point-of-Care Ultrasound (POCUS) in Pediatric Emergency Medicine (PEM), the most comprehensive specialty-specific guidelines to date.
The Royal College of Physicians and Surgeons of Canada (RCPSC) is anticipated to significantly expand the role of POCUS in their objectives of training for Pediatric Emergency Medicine.
The Challenge
During our 2015 P2Network Conference, we discussed the major challenges that our members have faced in implementing POCUS in their settings. The members filled cue cards listing these challenges. A tally of those cards illustrates the largest common obstacle that we face today.Top 5 Issues in Implementing POCUS
- Lack of Interest 52%
- QA; Competency; Credentialing 19%
- Training 17%
- Clinical Pathway Integration 8%
- Image Documentation 4%
‘Lack of Interest’ Drilled Down
- Uninterested (Faculty) 33%
- Competing Priorities 22%
- Poor Buy-in (Radiology) 19%
- Poor Buy-in (Administration) 15%
- Uninterested (Fellows) 11%
