When to incorporate point-of-care ultrasound (POCUS) into the initial assessment of acutely ill patients: a pilot crossover study to compare 2 POCUS-assisted simulation protocols

Cardiovasc Ultrasound. 2018 Sep 11;16(1):14. doi: 10.1186/s12947-018-0132-0.


Background: The purpose of this study was to determine the ideal timing for providers to perform point-of-care ultrasound (POCUS) with the least increase in workload.

Methods: We conducted a pilot crossover study to compare 2 POCUS-assisted evaluation protocols for acutely ill patients: sequential (physical examination followed by POCUS) vs parallel (POCUS at the time of physical examination). Participants were randomly assigned to 2 groups according to which POCUS-assisted protocol (sequential vs parallel) was used during simulated scenarios. Subsequently, the groups were crossed over to complete assessment by using the other POCUS-assisted protocol in the same patient scenarios. Providers' workloads, measured with the National Aeronautics and Space Administration Task Load Index (NASA-TLX) and time to complete patient evaluation, were compared between the 2 protocols.

Results: Seven providers completed 14 assessments (7 sequential and 7 parallel). The median (IQR) total NASA-TLX score was 30 (30-50) in the sequential and 55 (50-65) in the parallel protocol (P = .03), which suggests a significantly lower workload in the sequential protocol. When individual components of the NASA-TLX score were evaluated, mental demand and frustration level were significantly lower in the sequential than in the parallel protocol (40 [IQR, 30-60] vs 50 [IQR, 40-70]; P = .03 and 25 [IQR, 20-35] vs 60 [IQR, 45-85]; P = .02, respectively). The time needed to complete the assessment was similar between the sequential and parallel protocols (8.7 [IQR, 6-9] minutes vs 10.1 [IQR, 7-11] minutes, respectively; P = .30).

Conclusions: A sequential POCUS-assisted protocol posed less workload to POCUS operators than the parallel protocol.

Keywords: Critical illness; Point-of-care; Simulation; Ultrasound.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Computer Simulation*
  • Critical Illness*
  • Cross-Over Studies
  • Education, Medical, Graduate / methods*
  • Female
  • Health Personnel / education*
  • Humans
  • Male
  • Pilot Projects
  • Point-of-Care Systems*
  • Ultrasonography*
  • Workload