Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-20T17:31:25.934Z Has data issue: false hasContentIssue false
  • English
  • Français

Point-of-care ultrasonography adoption in Canada: using diffusion theory and the Evaluation Tool for Ultrasound skills Development and Education (ETUDE)

Published online by Cambridge University Press:  04 March 2015

Michael Y. Woo ,
Jason R. Frank  and
A. Curtis Lee
Michael Y. Woo*
Affiliation:
Department of Emergency Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON
Jason R. Frank
Affiliation:
Department of Emergency Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON
A. Curtis Lee
Affiliation:
School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, NSW, Australia
*
Department of Emergency Medicine, University of Ottawa, 1053 Carling Avenue, Ottawa, ON K1Y 4E9; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

Point-of-care ultrasonography (PoCUS) first appeared in the 1980s in North America, but the extent of the diffusion of its adoption is unknown. We characterized early PoCUS adoption by emergency physicians in Canada and its barriers to use using Rogers' diffusion of innovations theory.

Methods:

We developed a questionnaire based on a pilot study and literature review to assess past, current, and potential use of PoCUS and potential barriers to adoption. A Dillman technique for electronic surveys was used for dissemination. Using Rogers' diffusion of innovations theory, we developed and validated the Evaluation Tool for Ultrasound skills Development and Education (ETUDE). ETUDE scores allowed categorization of respondents into innovators, early adopters, majority, and nonadopters. Descriptive statistics, correlations, and x2 statistics were used to analyze the data.

Results:

The 296 respondents (36.4% of 814 surveyed) had a median age of 40 and were 72.5% male. Adoption scores using ETUDE revealed nonadopters (18.8%), majority (28.7%), early adopters (34.5%), and innovators (18.0%). Respondents endorsed “always” using PoCUS currently and in the future for focused assessment with sonography in trauma (FAST) (current 41.8%/future 88.4%), first trimester pregnancy (current 23.3%/future 73.7%), suspected abdominal aortic aneurysm (current 32.7%/future 92.6%), basic cardiac indications (current 30.7%/future 87.5%), and central venous catheterization (current 17.0%/future 80.3%). Several barriers to PoCUS were identified for part-time emergency physicians and those working in inner-city/urban/suburban settings.

Conclusion:

This is the first study to determine the state of adoption and barriers to the introduction of PoCUS in Canadian emergency medicine practice. The novel validated ETUDE instrument should be used to evaluate the uptake of PoCUS over time.

Keywords

emergency medicinepoint-of-care ultrasonographysurvey
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 5 , September 2014 , pp. 345 - 351
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

References

REFERENCES

1. American College of Emergency Physicians. Emergency ultrasound guidelines 2008. Available at: (accessed February 20, 2013).Google Scholar
2. Canadian Association of Emergency Physicians. Use of point of care ultrasonography by emergency physicians. CAEP Position Statement. CJEM 2012;14:106–12.Google Scholar
3. Moore, CL, Copel, JA. Point-of-care ultrasonography. N Engl J Med 2011;364:749–57, doi:10.1056/NEJMra0909487.CrossRefGoogle ScholarPubMed
4. Kimura, A, Otsuka, T. Emergency center ultrasonography in the evaluation of acute hemoperitoneum: a prospective study. J Trauma 1991;31:20–3, doi:10.1097/00005373-199101000-00004.Google Scholar
5. Aufschnaiter, M, Kofler, H. [Sonographic acute diagnosis in polytrauma]. Aktuelle Traumatol 1983;13:55–7.Google ScholarPubMed
6. Trott, A. Ultrasonography in emergency medicine. J Emerg Med 1984;1:549, doi:10.1016/0736-4679(84)90011-8.Google Scholar
7. Hoppmann, RA, Riley, R, Fletcher, S, et al. First World Congress on Ultrasound in Medical Education hosted by the University of South Carolina School of Medicine. J S C Med Assoc 2011;107:189–90.Google ScholarPubMed
8. Hoppmann, RA, Rao, VV, Poston, MB, et al. An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience. Crit Ultrasound J 2011;3:1–12, doi:10.1007/s13089-011-0052-9.Google Scholar
9. Rogers, EM. >Diffusion of innovations. 5th ed. New York: Free Press; 2003.Google Scholar
10. Dillman, D. Mail and telephone surveys: the Total Design Method. New York: Wiley; 1978.Google Scholar
11. Dillman, D, Smyth, M. Design effects in the transition to web-based surveys. Am J Prev Med 2007;32:S90–6, doi:10.1016/j.amepre.2007.03.008.CrossRefGoogle ScholarPubMed
12. Canadian Emergency Ultrasound Society. Recommended standards. Available at: (accessed February 20, 2013).Google Scholar
13. Bajwa, GS, Stiell, I, Hebert, G, Lee, J. The availability of “urgent” ultrasound in Canadian emergency departments. A survey of emergency department directors. CJEM 2000;2:172.Google Scholar
14. Royal College of Physicians and Surgeons of Canada. Objectives of training in emergency medicine. Available at: (accessed February 20, 2013).Google Scholar
15. Mackey, DS, Steiner, IP, editors. National guidelines: family medicine - emergency medicine residency programs. Available at: (accessed February 20, 2013).Google Scholar
16. Kim, DJ, Theoret, J, Liao, MM, et al. The current state of ultrasound training in Canadian emergency medicine programs: perspectives from program directors. Acad Emerg Med 2012;19:1073–8, doi:10.1111/j.1553-2712.2012.01430.x.Google Scholar
17. The National Quality Forum. Safe practices for better health care. A consensus report. Washington, DC, 2003. Available at: (accessed February 20, 2013).Google Scholar
18. National Institute for Clinical Excellence. NICE technology appraisal guidance No. 49: guidance on the use of ultrasound locating devices for placing central venous catheters. London: NICE; September 2002. Available at: (accessed February 20, 2013).Google Scholar
19. Blaivas, M, Sierzenski, P, Pleque, D, Lambert, M. Do emergency physicians save time when locating a live intrauterine pregnancy with bedside ultrasonography? Acad Emerg Med 2000;7:988–93, doi:10.1111/j.1553-2712.2000.tb02088.x.CrossRefGoogle ScholarPubMed
20. Plummer, D, Clinton, J, Matthew, B. Emergency department ultrasound improves time to diagnosis and survival in ruptured abdominal aortic aneurysm [abstract]. Acad Emerg Med 1998;5:417.Google Scholar
21. Randolph, AG, Cook, DJ, Gonzales, CA, Pribble, CG. Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med 1996;24:2053–8, doi:10.1097/00003246-199612000-00020.Google Scholar
22. Patrick, J. Training: research and practice. London: Academic Press; 1992.Google Scholar