Point-of-care ultrasound in rural New Zealand: Safety, quality and impact on patient management.

OBJECTIVE: To evaluate the safety, quality and impact of point-of-care ultrasound on patient management when performed by rural generalist doctors.

DESIGN: Cross-sectional descriptive study.

SETTING: Six rural small hospitals serving a range of communities in rural New Zealand.

PARTICIPANTS: All generalist doctors practising ultrasound in the study hospitals.

MAIN OUTCOME MEASURES: Technical quality, accuracy, impact on diagnostic certainty, patient disposition and overall patient care.

RESULT: Participants correctly interpreted 90% of images and a similar percentage of point-of-care ultrasound findings when compared with the results of formal imaging or the final diagnosis. In total, 87% of scans contributed to the diagnostic process, changing the diagnostic probability. There was a 4% overall reduction in the number of patients needing hospital admission or transfer to an urban base hospital. The overall impact on patient care was positive for 71% of point-of-care ultrasound scans. Three percent of scans had the potential for patient harm.

CONCLUSION: Rural generalists' practise a broad scope of point-of-care ultrasound that, when used as a part of the full clinical assessment, has a positive impact on patient care, improving diagnostic certainty and reducing the need for hospital admission and inter-hospital transfer. There are challenges in learning and maintaining the skills needed to practise a high standard of point-of-care ultrasound in this context. Further consideration needs to be given to the development safe scopes of practice, training, credentialing and quality assurance.