Point-of-care ultrasound use over six-month training period in Rwandan district hospitals

• Main Authors: P.C. Henwood*, J.S. Rempell, A.S. Liteplo, A.F. Murray, D.C. Mackenzie, M.M. Leo, S. Vaillancourt, E.R. Douglass, D. Dukundane, S. Rulisa, A.J. Dean, V.E. Noble
• Format: Article
• Language: English
• Published: Elsevier 2013-12-01
• Series: African Journal of Emergency Medicine
• Online Access: http://www.sciencedirect.com/science/article/pii/S2211419X13001316

Point-of-care ultrasound (POCUS) is an effective diagnostic technology in resource-limited settings. There is increasing interest in introducing ultrasound training in such environments, but few reports describing long-term follow-up and impact of a POCUS program in a resource-limited setting. We introduced a POCUS program in Rwanda, and sought to determine the number and type of ultrasounds performed, the impact of a remote quality assurance (QA) program, and the effect of POCUS on patient management. Methods: Seventeen Rwandan physicians underwent a ten-day training course in POCUS in Kigali, Rwanda. Post-course, participants tracked the ultrasounds they performed using a cloud-based storage system, recorded clinical impressions, and received periodic QA with on-site proctoring over a six-month follow-up. Remote QA to evaluate image quality was performed by five emergency ultrasound fellowship-trained clinicians. Images were graded on a scale of 0–4. (0 = no meaningful image, 2 = adequate, 4 = outstanding). Trainees also documented how POCUS changed clinical management. Results: Over six months, 1158 ultrasounds were performed and logged by fifteen participants at eleven regional hospitals. 590 (50.9%) had matched images and interpretations available for review. Abdominal ultrasound was the most frequently performed application (19.7%), followed by liver (14.6%), obstetrics (14.5%), renal (12.4%), and spleen (11%). Across all applications, the mean score was 2.5 (SD ± 0.11, 95% confidence interval, 2.39–2.54). Ultrasound resulted in a management change in 84% of cases. Major changes in management related to medication choice (42.4%), admission (30%), transfer to a higher level of care (28.1%), and performance of procedures (23.3%). Conclusions: During this six-month training program in Rwanda, participants used POCUS for a range of applications. The remote QA process captured 51% of ultrasounds performed. Of scans with QA, the average score was adequate to good. POCUS routinely changed clinical management. This study demonstrates the impact of POCUS in a resource-limited setting.