In the early days of the pandemic, a patient with fever and shortness of breath entered Kootenay Lake Hospital’s isolation zone in Nelson, British Columbia (BC). Dr. Kevin Fairbairn, the family/emergency physician on duty, reviewed the patient’s workup, but with results only indicating an elevated white blood cell count, slightly elevated C-reactive protein level, and clear chest x-ray, diagnosis was difficult.
Luckily, Dr. Fairbairn had another diagnostic tool on hand. From his pocket, he grabbed a small, handheld, wi-fi enabled ultrasound scanner, which can show detailed ultrasound images when connected to a secure app on his smart phone. By simply guiding the scanner over the patient’s chest and examining the images appearing on his phone, Dr. Fairbairn immediately saw something concerning.
Point-of-care ultrasound is helping rural physicians deliver faster, more accurate diagnoses and bringing access to ultrasound closer to home for patients.Dr. Virginia Robinson
“I remember thinking, ‘That’s weird—isolated inferior b-lines,’” says Dr. Fairbairn. “I admitted the patient for pneumonia, just in case, and kept them in isolation until their COVID-19 swab came back from the lab. It was positive. The handheld ultrasound assessment raised clinical suspicion for COVID-19 before lab diagnosis and led to my decision to continue isolating the patient. If I’d released the patient into another part of the hospital, or home, an outbreak could have easily occurred.”
Despite the fact that ultrasound has been a key diagnostic tool in BC’s healthcare system for years, access to it—particularly in rural and remote areas of the province—remains limited due to its bulk and expense. Radiologists are also often required to conduct and analyze complex scans. As a result, rural patients must often be transported, or travel themselves, to an urban centre to receive an ultrasound. This increases the time to diagnosis and treatment, as well as costs to the health system and patients.
The handheld ultrasound assessment raised clinical suspicion for COVID-19 before lab diagnosis and led to my decision to continue isolating the patient. If I’d released the patient … an outbreak could have easily occurred.Dr. Kevin Fairbairn
“Physicians across Canada, and particularly in rural BC, are recognizing the benefits of bringing handheld ultrasound devices into their practice,” says Dr. Virginia Robinson, who leads IN PoCUS for RCCbc and practices as a family/emergency physician in Fernie, BC. “These devices are cost-effective, easy to use with proper training, and simple to clean. Point-of-care ultrasound is helping rural physicians deliver faster, more accurate diagnoses and bringing access to ultrasound closer to home for patients.”
Through IN PoCUS, RCCbc and its partners have equipped 50 rural physicians in BC with a handheld ultrasound device for use in their community clinics and emergency departments. Ongoing and accredited training is provided to rural IN PoCUS physicians through UBC Continuing Professional Development’s Hands-on Ultrasound Education (HOUSE) course (live and online versions), the Rural PoCUS Rounds Summer Series, and the Coaching and Mentoring Program. Dr. Robinson and her team of expert ultrasound educators also offer one-on-one training for rural physicians upon request. And virtual physicians with the Real-Time Virtual Support program’s RuDI pathways provide rural physicians with friendly point-of-care ultrasound training and assistance reading scans 24 hours a day, seven days a week.
In exchange for their place in the IN PoCUS project, rural physicians must upload their ultrasound images into a cloud. The images are then anonymized by Providence Health and submitted into a provincial point-of-care ultrasound database, called Picture Archiving and Communication Systems (PACS). The database not only provides quality assurance, but acts as a provincial reference, which, when fully developed, will use artificial intelligence to help physicians make more accurate and quicker diagnoses.
“The contribution by IN PoCUS physicians to the PACS database is crucial for the sustainability and effectiveness of point-of-care ultrasound use in rural BC,” explains Dr. Robinson. “In addition to pioneering point-of-care ultrasound use in our province, they’re building the backbone of this database, which will eventually help them and others to deliver faster, more accurate diagnosis for rural patients. PACS will also serve as an important tool to educate rural physicians to analyze scans.”
A thorough evaluation of BC’s IN PoCUS project is being conducted by Dr. Jude Kornelson at UBC. Results of the evaluation are expected towards the end of the year and will aid Dr. Robinson and her colleague, Dr. Tracy Morton, in the ongoing development of a Rural Point-of-Care Ultrasound Strategy for BC. The Strategy aims to continue building point-of-care ultrasound expertise amongst rural providers in the province. Rural health providers can get involved in the development of the Strategy by contacting Dr. Robinson or Dr. Morton.
The contribution by IN PoCUS physicians to the PACS database is crucial for the sustainability and effectiveness of point-of-care ultrasound use in rural BC.Dr. Virginia Robinson
“Through IN PoCUS, we’re creating tremendous momentum in bringing ultrasound diagnoses closer to home for rural physicians and patients—the benefits of which have become even clearer during the COVID-19 pandemic,” says Dr. Robinson. “We’ll use this momentum to advance point-of-care ultrasound use in rural BC. It’s crucial for creating greater health equity for all British Columbians, no matter where they live in our province.”