About the project

Point of care ultrasound scanning (POCUS) is a procedure commonly used at the patient’s bedside, often within acute medicine, to aid assessment and management of patients. As ultrasound technology has advanced, POCUS enables healthcare staff to use a handheld probe connected to a tablet or smartphone, to support diagnosis decision-making. POCUS can positively impact capacity within radiology, by improving patient flow and providing more timely diagnostics.

Through Health Innovation West Midlands’ (HIWM) work, several healthcare organisations around the West Midlands highlighted interest in trialling POCUS in their clinical areas, including the Birmingham Children’s Haemophilia (BCH) team.

What is the aim of POCUS?

The POCUS project adopted a human factors approach to the implementation of POCUS to improve the diagnosis, treatment, and management of paediatric haemophilia patients with suspected joint bleeds. Repeated bleeding into a joint break can cause joint damage, meaning timely treatment is crucial if a bleed is suspected. If a child with haemophilia has a joint or muscle bleed, it needs treatment with a replacement for the missing clotting protein as soon as possible.

By working with HIWM, the BCH team hoped to improve the patient journey and diagnostic pathway, and enable the haemophilia nurse or physiotherapist to undertake ultrasound scanning independently, to inform decision making, benefitting both staff and patients.

Our Approach

A hierarchical task analysis (HTA) was conducted to understand the existing process for suspected bleed patients to be referred to radiology for an ultrasound. Information from discussions with staff, observations, and the HTA, was used to assist with the identification of where and how the pathway could benefit from POCUS.

Baseline data was also collected to gain a greater understanding of the patient pathway, this included:

• Date of presentation to clinic and ultrasound (if performed)
• Length of wait for ultrasound results
• Whether a bleed was confirmed
• Whether factor medication was prescribed

Adoption of a human factors approach, before the trial of the POCUS equipment, ensured full consideration of how the patient pathway would change with the introduction of a nurse-led ultrasound scan. Additional work focused on understanding and reducing the risk of staff developing musculoskeletal problems, from using POCUS, in the future.

Outcome

After the implementation of the project, the results revealed:

• The waiting time for an ultrasound scan in the radiology department varied from 10 minutes to a week
• 33% of ultrasound scan patients were confirmed to have a joint bleed and were prescribed factor clotting medication
• 50% of patients without an ultrasound scan were prescribed factor clotting medication as a precaution, due to an ultrasound scan not being immediately available

User trials of the POCUS equipment found that although the equipment was portable, easy to use, and affordable, the probe was heavy and too large for young patients. This led to further trials with less portable equipment, with a range of ultrasound probe sizes, which was chosen for long-term implementation.

Although POCUS was not the final solution, the project gave haemophilia staff the skills to perform ultrasound scans, hoping to:

• Reduce the number of patients prescribed factor medication unnecessarily
• Reduce the amount spent on factor medication
• Reduce patient waiting time
• Provide reassurance for patients and carers
• Reduce ultrasound requests to radiology

HIWM Innovator Support team continues to support the POCUS team to further develop their work and to secure further adoption and then spread of the technology.

Find out more

For more information please contact a member of the team below.

• Fran Ives, Human Factors Specialist: Frances.Ives@healthinnovationwm.org