Implementing a quality framework for storing emergency department point-of-care ultrasound examinations on a picture archiving and communication system.

Introduction: There is a lack of a quality framework in most emergency departments despite the set national standards for storing point-of-care ultrasound (PoCUS) examinations. To explore and address this problem, a quality improvement project was undertaken in an emergency department. A consecutive sample of the most recent PoCUS examinations in a district general hospital emergency department in the United Kingdom was audited. None was handled and stored on the picture archiving and communication system (PACS). Quality improvement project tools, such as plan, do, study, act (PDSA) cycles, were utilised to analyse and improve practice. The PoCUS machine was connected to the local area network to allow transfer of images to PACS. For requesting and booking the examinations, specific requests on the integrated clinical environment were created akin to the computerised radiology information system codes. Other interventions were introduced such as a reporting proforma. The success of the quality improvement project depended partly on key stakeholders such as emergency department consultants, radiology staff and PACS teams. The number of stored examinations on PACS was the main process measure, but others were also considered, for example reporting and documentation.

Results: Over a 10-month period (September 2018-July 2019), there were three PDSA cycles, which included a total of 195 performed emergency department PoCUS examinations. The implemented quality framework led to 90% of examinations stored to PACS, with a mean of 63%. No negative impacts were reported, and feedback was positive.

Conclusion: Implementing a quality framework for storing emergency department PoCUS examinations on PACS is feasible and significantly improves practice. Further work is required to sustain and improve the process.