Evaluation of Implementation of a National Point-of-Care Ultrasound Training Program

Learn more about:
Related Clinical Trial
Norwegian Randomized Trial on Indocyanine Green Cholangiography Utility for Laparoscopic Cholecystectomy, Prestudy A Phase 2 Study Evaluating Efficacy, Safety and Tolerability of Different Doses and Regimens of Allocetra-OTS for the Treatment of Organ Failure in Adult Sepsis Patients Effect Of Early Versus Delayed Laparoscopic Cholecystectomy In Patients With Grade II Cholecystitis Effectiveness of Empirical Antibiotic Use in Mild to Moderate Acute Inflammatory Gallbladder Disease ENDOSCOPIC ULTRASONOGRAPHY (EUS) GUIDED GALLBLADDER DRAINAGE WITH TWO MONTHS STENT REMOVAL FOR ACUTE CHOLECYSTITIS: A PROSPECTIVE STUDY The Efficacy and Safety of Using Prophylactic Abdominal Drainage After Cholecystectomy M-Tapa Block for Laparoscopic Cholesistectomy The Comparison of Hemodynamic Effects Between Remimazolam-remifentanil and Propofol-remifentanil in Patients Undergoing Laparoscopic Cholecystectomy Impact of Percutaneous Cholecystostomy in the Management of Acute Cholecystitis. Indocyanine Green Fluorescent Cholangiography and Intraoperative Angiography With Laparoscopic Cholecystectomy Fetal Outcomes Among Pregnant Emergency General Surgery Patients Usefulness of the CADISS® System for the Cleavage of Severe Adhesions in Cholecystectomy SPY Fluorescence Imaging Systems and Indocyanine Green as a Tool for Developing Intelligent Peri-Operative Imaging Early Laparoscopic Cholecystectomy Versus Percutaneous Cholecystostomy in Grade II Acute Cholecystitis Guidelines Validation and Comparison of Scores for Prediction of RIsk for Post-operative Major Morbidity After Cholecystectomy in Acute Calculous Cholecystitis (SPRIMACC) GB34 Acupuncture in Acute Cholecystitis Low Dose ICG for Biliary Tract and Tumor Imaging Visualization of the Extrahepatic biliaRy Tree Trial Gallbladder Cryoablation in High-Risk Patients Hong Kong Follow up Protocol After EUS Gallbladder Drainage for Acute Cholecistitis Bikini Scarless Laparoscopic Cholecystectomy for Morbid Obesity as a Day Case. Naldebain for Pain Management of Laparoscopic Cholecystectomy Operative vs Non-Operative Management of Acute Appendicitis and Acute Cholecystitis in COVID-19 Positive Patients Acute Cholecystitis With Concomitant Choledocholithiasis: Unicentric Study of Prevalence and Predictive Factors Effectiveness of Prophylactic Antibiotics Therapy in Laparoscopic Cholecystectomy on Infection Rate Necessity of Preoperative Empirical Antibiotic Use in Acute Cholecystitis Safety and Feasibility of ActivSightTM in Human Indocyanine Green to Visualize Critical View of Safety During Laparoscopic Cholecystectomy for Acute Cholecystitis US-guided Trocar Versus Seldiger Technique for Percutaneous Cholecystostomy Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis in the Elderly: A Retrospective Study. A Scoring System for Difficult Laparoscopic Cholecystectomy RISK FACTORS FOR NECROTIC CHOLECYSTITIS DURING COVID-19 PANDEMIC: THE ChoCO WSES PROSPECTIVE MULTICENTER OBSERVATIONAL STUDY Evaluation of a Protocol for Multidisciplinary Management of Acute Cholecystitis. How to Predict Postoperative Complications After Early Laparoscopic Cholecystectomy for Acute Cholecystitis: the Chole-Risk Score Ondansetron Effect on Pain Relief After Laparoscopic Cholecystectomy Different Timing for Early Laparoscopic Cholecystectomy in Acute Calcular Cholecystitis Prognostic Indicators as Provided by the EPIC ClearView WSES International Register of Emergency Surgery Evaluation of Implementation of a National Point-of-Care Ultrasound Training Program Deep Versus Moderate Neuromuscular Blockade During Laparoscopic Surgery Study Comparing Tigecycline Versus Ceftriaxone Sodium Plus Metronidazole in Complicated Intra-abdominal Infection (cIAI) Cefoperazone/Sulbactam In The Treatment Of Serious Intra-Abdominal And Hepatobiliary Infections. Prospective Validation of “Cholecystectomy First” Strategy for Gallstone Migration ONSD According to the Position During Laparoscopy Risk of Umbilical Trocar-site Hernia After SILC Cholecystectomy Versus Conventional Cholecystectomy Drainage or Not for Laparoscopic Cholecystetomy UDCA for Symptomatic Gallstone Disease Small-incision Open Cholecystectomy or Laparoscopic Cholecystectomy for Gallbladder Disease Study Comparing Tigecycline Versus Ceftriaxone Sodium Plus Metronidazole in Complicated Intra-abdominal Infection Transvaginal Cholecystectomy Using Endoscopic Assistance Doripenem in the Treatment of Complicated Intra-Abdominal Infections Doripenem in the Treatment of Complicated Intra-Abdominal Infections The Use of Fluorescent Imaging for Intraoperative Cholangiogram During Laparoscopic Cholecystectomy No Need for Neuromuscular Blockade in Daycase Laparoscopic Surgery Efficacy of Proficiency-based Versus Free Laparoscopic Training in Cholecystectomy on a Virtual Reality Simulator Single Port Access (SPA) Cholecystectomy Versus Standard Laparoscopic Cholecystectomy Single-Incision Laparoscopic Cholecystectomy Versus Traditional Laparoscopic Cholecystectomy Evaluation of PC 6 “Neiguan” With Conventional Acupuncture to Prevent PONV After Laparoscopic Cholecystectomy. Role of the Right Portal Pedicle and Rouviere’s Sulcus as an Anatomic Landmark in Laparoscopic Cholecystectomy DGT Versus TPS in Patients With Initial PD Cannulation by Chance; Prospective Multi-center Study Laparoscopic Transvaginal Hybrid Cholecystectomy: a Prospective Data Collection. NOTES-Assisted Laparoscopic Cholecystectomy Surgery EUS-guided Transenteric Drainage With a Novel Lumen-apposing Metal Stent Effect of Vitamin C on Postoperative Pain After Laparoscopic Cholecystectomy NOVOsyn® for Trocar Incision After Laparoscopic Appendectomy and Cholecystectomy Fluorescence Cholangiography During Cholecystectomy – a RCT Outcome of IV Acetaminophen Use in Laparoscopic Cholecystectomies in Patients at Risk of OSA FALCON: a Multicenter Randomized Controlled Trial Cholecystectomy First vs Sequential Common Bile Duct Imaging + Cholecystectomy Initial Experience With a New Laparoscopic Based Robotically Assisted Surgical System for Cholecystectomy Spinal Versus General Anesthesia for Laparoscopic Cholecystectomy 3D Versus 4K Laparoscopic Cholecystectomy Laryngeal Mask Airway Supreme Versus the Tracheal Tube as an Airway Device in Elective Laparoscopic Cholecystectomy Effect of Modified Stylet Angulation on the Intubation With GlideScope® Evaluation of Closed-loop TIVA Propofol, Sufentanil and Ketamine Guided by BIS Monitor BDD With UDCA Therapy After Laparoscopic Cholecystectomy Transmuscular Quadratus Lumborum Block for Laparoscopic Cholecystectomy Postoperative Pain Results According to Pressure to Form Pneumoperitoneum Benefits of Glycopyrrolate on Intubation With Rigid-videostylet (OptiScope®) Prediction of Postoperative Pain by Injection Pain of Propofol Transient ECG Changes in Patients With Acute Biliary Disease Randomized Control Trial of Intraperitoneal Bupivacaine During Cholecystectomy Establishing Visualization Grading Scale on LESS Cholecystectomy Improving Informed Consent Process for Percutaneous Cholecystostomy in the Emergency Department Natural Orifice Transgastric Endoscopic Surgical Removal of the Gallbladder Anesthesia With Propofol, Dexmedetomidine and Lidocaine Infusions for Laparoscopic Cholecystectomy A Clinical Study of Chinese Domestic Surgical Robot Laparoscopic Cholecystectomy: Study of Left Side of Laparoscopic Cholecystectomy Tracheal Intubation in Patient With Semi-rigid Collar Immobilization of the Cervical Spine: A Comparison of Fiberoptic Bronchoscope Assisted With Pentax-airway Scope and Fiberoptic Bronchoscope Alone Effect of Intraoperative Nefopam on Acute Pain After Remifentanil Based Anesthesia Ultrasound Guided Subcostal Transversus Abdominis Plane Versus Paravertebral Block in the Laparoscopic Cholecystectomy Near Infrared Fluorescence Cholangiography (NIRF-C) During Cholecystectomy Effects of Drainage in Laparoscopic Cholecystectomy Observation vs Early Removal of LAMS in EUS Guided Cholecystoenterostomy Study of Pain Perception Between Males and Females Following Laparoscopic Cholecystectomy Drainage is Not Necessary Procedure After Laparoscopic Cholecystectomy Due to Severe Acute Cholecystitis Comparison of Morbidity After Laparoscopic Cholecystectomy for Acutely Inflamed Gall Bladder With and Without Drain Early Versus Delayed Cholecystectomy If Chronic Gallbladder Diseases Increase the Incidence of PEC Remote Ischemic Preconditioning in Patients Undergoing Acute Minor Abdominal Surgery Use of Robotics for Cholecystectomy; Retrospective Review of Outcomes, Set Up and Learning Curves Near Infrared Fluorescence Cholangiography (NIRF-C) During Cholecystectomy — Use in Acute Cholecystitis Sub-Study The Relationship Between Post-ERCP-choledocholithiasis and Gallbladder Status Endoscopic Nasogallbladder Drainage Versus Gallbladder Stenting Before Cholecystecomy Enhanced Recovery in Laparoscopic Cholecystectomy Empirical Antibiotics in Acute Inflammatory Gallbladder Disease Primary EUS-GBD in Patients With Unresectable Malignant Biliary Obstruction and Cystic Duct Orifice Involvement. Laparoscopic Cholecystectomy for Acute Cholecystitis After 72 Hours of Symptoms Bile Aspiration vs Drain in Acute Cholecystitis Interest of Intravenous Cholangiography With Indocyanine Green in the Context of Laparoscopic Cholecystectomy for Grade 1 and 2 Acute Gallstone Cholecystitis Fluorescent Cholangiography During Acute Cholecystitis Reduction of Operating Time by a Smoke Electroprecipitation Device for Acute Cholecystitis Piperacllin Versus Placebo in Patients Undergoing Surgery for Acute Cholecystitis Ultrasonically Activated Scalpel Versus Electrocautery Based Dissection in Acute Cholecystitis Trial Is it Fair to Use Antibiotics After Laparoscopic Cholecystectomy for the Patients With Acutely Inflamed Gallbladder? Percutaneous Transhepatic Cholangiography (PTHC) in Acute Cholecystitis and Clinical Outcomes Acute Cholecystitis – Early Laparoscopic Surgery Versus Antibiotic Therapy and Delayed Elective Cholecystectomy Scoring System in Acute Calculous Cholecystitis Is it Safe to do Laparoscopic Cholecystectomy for Acute Cholecystitis up to Seven Days? Fast Track Pathway to Accelerated Cholecystectomy Laparoscopic Cholecystectomy or Conservative Treatment in the Acute Cholecystitis of Elderly Patients Efficacy and Safety of Floseal for the Haemostasis During Laparoscopic Cholecystectomy in Acute Cholecystitis (GLA) Acute Cholecystitis: Early Versus Delayed Laparoscopic Cholecystectomy; Randomized Prospective Study Short Term Outcomes of Acute Cholecystitis Managed at a University Hospital Harmonic in Laparoscopic Cholecystectomy for Acute Cholecystitis EUS-guided Gallbladder Drainage Instead of Laparoscopic Cholecystectomy for Acute Cholecystitis. A Feasibility Study. Prospective Trial for Endoscopic Ultrasound Guided Gallbladder Drainage for Acute Cholecystitis in High Risk Patients A Randomized Controlled Trial on EGBD vs PC for Acute Cholecystitis. Magnetic Resonance Cholangiography and Intraoperative Cholangiography in Acute Cholecystitis The Role of Ultrasound in Cholecystitis AXIOS™ for Gallbladder Drainage as an Alternative to Percutaneous Drainage IDE Extended Antibiotic Therapy in Postoperative of Laparoscopic Cholecystectomy in Acute Cholecystitis The Real World of Acute Cholecystitis Functional MRC With Eovist for Acute Cholecystitis FDG-PET/CT in the Evaluation of Patients With Suspected Cholecystitis

Brief Title

Evaluation of Implementation of a National Point-of-Care Ultrasound Training Program

Official Title

Evaluation of Implementation of a National Point-of-Care Ultrasound Training Program

Brief Summary

      This VA QUERI Partnered Evaluation Initiative will evaluate the impact of an immersive
      Point-of-care Ultrasound (POCUS) Training Course on provider skill acquisition and retention;
      the frequency of POCUS use by trained providers; and the barriers/facilitators to POCUS in
      the VHA. Data sources include pre- and post-course assessment tools, medical coding data, and
      course evaluations. Providers that participate in the POCUS Training Course will be compared
      to control providers from wait-listed facilities. Additionally, participating facilities vs.
      wait-listed facilities for the POCUS Training Course will be compared. Findings from this
      project will guide ongoing efforts of the investigators' operating partners, VA Specialty
      Care Centers of Innovation (SCCI) and the VA Simulation Learning and Research Network
      (SimLEARN), to develop a national POCUS training program and facilitate implementation of
      POCUS use system-wide in the VA healthcare system.

Detailed Description

      Background: Point-of-care ultrasonography (POCUS) has been shown to reduce procedure-related
      complications from invasive bedside procedures, reduce time to diagnosis, and reduce
      ancillary testing, which ultimately reduces patient radiation exposure and healthcare costs.
      Despite its potential advantages, POCUS has not been universally adopted in healthcare due to
      limited numbers of providers trained in use of POCUS. The VA's Simulation Learning, Education
      and Research Network (SimLEARN) and Specialty Care Centers of Innovation (SCCI) have launched
      a collaborative initiative to develop a national POCUS training program. The goal of this
      collaborative training program is to teach VA providers basic diagnostic and procedural
      applications of POCUS. The proposed project will evaluate the effectiveness of an immersive
      POCUS training course developed by SimLEARN on provider skill acquisition and retention,
      frequency of use, and identify barriers/facilitators to POCUS use at participating VHA

      Methods: Approximately 120 participants from a convenience sample of 20 diverse VA facilities
      will participate in a 2.5-day immersive POCUS training course at the SimLEARN National
      Simulation Center in Orlando during fiscal year 2017. The investigators' evaluation plan will
      collect data from facility Chiefs of Staff, providers from facilities participating in POCUS
      training, and providers from wait-listed facilities at different time points using different
      assessment tools: VA Facility POCUS Survey, Provider POCUS Survey, Brief Provider POCUS
      Survey, Pre-/Post-course Knowledge and Skills Test, and Coding Data.

      Objective 1: Evaluate provider skill acquisition and retention, and frequency of POCUS use
      after participation in the POCUS Training Course. Pre- and post-course testing will be used
      to assess acquisition of knowledge and technical skills to perform POCUS exams. Post-course
      testing for knowledge and skill retention, and frequency of use, will be performed 6-9 months
      after the training course.

      Objective 2: Determine the effect of the POCUS Training Course and implementation
      facilitation on facility-level frequency of POCUS use. Facilities with providers that
      infrequently use POCUS will be eligible to participate in the POCUS Training Course. However,
      not all facilities will be able to be accommodated in the 1st year of the training program,
      requiring a facility waiting list. Facilities with providers participating in the POCUS
      Training Course will be compared to wait-listed facilities with regard to frequency of POCUS
      use. Using the Brief Provider POCUS Survey, frequency of POCUS use by providers in both
      participating and waitlisted facilities will be compared. Additionally, coding data will be
      reviewed to assess frequency of procedures performed with and without imaging guidance and
      procedural complication rates comparing the two groups of facilities.

      Objective 3: Determine provider and facility-level barriers and facilitators to POCUS use.
      Provider and facility-level barriers will be assessed using 3 tools: Provider POCUS Survey
      (trained providers), Brief Provider POCUS Survey (wait-listed and participating facilities),
      and Facility POCUS Survey (all facilities). Differences in barriers reported and their
      relationship to frequency of POCUS use will be compared.

      Objective 4: Development of POCUS Champions course to facilitate local implementation by
      addressing facility-level barriers. The POCUS Champions course will address several
      facility-level barriers to implementation that have been identified by the PEI: lack of image
      archiving, limited access to ultrasound machines, undefined credentialing/privileging
      processes, need for a quality assurance process, and lack of trained providers. The POCUS
      Champions course will include an annual 3-day boot camp, bi-monthly conference calls, and
      ongoing mentorship. The goal of the 3-day boot camp will be for Champions to prepare a local
      implementation plan that can be presented to their facility's leadership. During the
      bimonthly conference calls, a brief didactic on a focused topic will be presented followed by
      an update on local progress from each site. The initial goal of the POCUS Champions course is
      to facilitate implementation of POCUS use in VA facilities, starting with 4-6 facilities that
      can serve as models for other facilities. The research to date has identified these elements
      as core components of a successful POCUS program. The POCUS Champions course will support
      progress on intermediate milestones towards ensuring these core components are in place, to
      facilitate adoption, reach, and sustainment. This provides a roadmap to sustainable POCUS

      Deliverables: The primary deliverable will be report that will summarize the effect of
      training on provider skill acquisition and retention, frequency of use of POCUS, and barriers
      and facilitators to POCUS implementation. This project will guide SimLEARN's and SCCI's
      efforts to develop a National POCUS Training Program and implement POCUS use nationally in
      the VA healthcare system. Additionally, this report may serve as a roadmap for the VHA for
      implementation of similar simulation-based educational innovations.

Study Type


Primary Outcome

Change in Frequency of Point-of-care Ultrasound Use for Diagnostic and Procedural Applications at Baseline and 6-9 Months

Secondary Outcome

 Change in Point-of-care Ultrasound Knowledge From Baseline to 6-9 Months


Other Acute Illnesses Presenting to the Hospital

Study Arms / Comparison Groups

 Early Intervention
Description:  This cohort of 10 facilities will undergo early training by participating in the first 6 POCUS course sessions during FY17


* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.

Recruitment Information

Estimated Enrollment


Start Date

October 3, 2016

Completion Date

September 30, 2020

Primary Completion Date

June 29, 2018

Eligibility Criteria

        Inclusion Criteria:

        Selection of VA facilities invited to participate in the national POCUS training course was
        based on data from a national needs assessment conducted by the VA's Health Analysis and
        Information Group. VA facilities that meet all of the following inclusion criteria are
        eligible to send physicians to participate in the POCUS training course:

          1. Chief of staff desires POCUS training for his/her facility

          2. >=2 Service Chiefs from emergency medicine, critical care medicine, or hospital
             medicine desire training for his/her physicians, AND

          3. >=1 portable ultrasound machine(s) available to physicians within these services

        Exclusion Criteria:

          1. Chief of staff does not desire POCUS training for his/her facility

          2. <2 Service Chiefs from emergency medicine, critical care medicine, or hospital
             medicine desire training for his/her physicians, OR

          3. No portable ultrasound machine(s) available to physicians within these services




N/A - N/A

Accepts Healthy Volunteers

Accepts Healthy Volunteers


Nilam Jayant Soni, MD MSc, , 

Location Countries

United States

Location Countries

United States

Administrative Informations



Organization ID

PEX 16-003

Secondary IDs


Responsible Party


Study Sponsor

VA Office of Research and Development


 US Department of Veterans Affairs

Study Sponsor

Nilam Jayant Soni, MD MSc, Principal Investigator, South Texas Health Care System, San Antonio, TX

Verification Date

November 2020