*Result*: Co-designed point-of-care ultrasound program development and implementation at a Veterans Affairs emergency department.
Title:
Co-designed point-of-care ultrasound program development and implementation at a Veterans Affairs emergency department.
Authors:
Theophanous RG; Department of Emergency Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC, 27710, USA. Rebecca.theophanous@duke.edu.; Durham Veterans Affairs Healthcare System, Durham, NC, 27710, USA. Rebecca.theophanous@duke.edu., Staton CA; Department of Emergency Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC, 27710, USA.; Duke Global Health Institute, Duke University, Durham, NC, 27710, USA., Ragsdale LC; Durham Veterans Affairs Healthcare System, Durham, NC, 27710, USA., Tupetz A; Department of Emergency Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC, 27710, USA.; Duke Global Health Institute, Duke University, Durham, NC, 27710, USA., Peethumnongsin E; Department of Emergency Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC, 27710, USA., Eucker SA; Department of Emergency Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC, 27710, USA.
Source:
Internal and emergency medicine [Intern Emerg Med] 2026 Jan; Vol. 21 (1), pp. 253-263. Date of Electronic Publication: 2025 Apr 25.
Publication Type:
Journal Article
Language:
English
Journal Info:
Publisher: Springer Country of Publication: Italy NLM ID: 101263418 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1970-9366 (Electronic) Linking ISSN: 18280447 NLM ISO Abbreviation: Intern Emerg Med Subsets: MEDLINE
Imprint Name(s):
Publication: Milan : Springer
Original Publication: Rome, Italy : CEPI-AIM Group, 2006-
Original Publication: Rome, Italy : CEPI-AIM Group, 2006-
MeSH Terms:
Point-of-Care Systems*/trends , Point-of-Care Systems*/organization & administration , Program Development*/methods, Emergency Service, Hospital/organization & administration ; Ultrasonography/methods ; United States Department of Veterans Affairs/organization & administration ; United States Department of Veterans Affairs/statistics & numerical data ; Humans ; United States
References:
American College of Emergency Physicians. ACEP guidelines Policy Statement. Ultrasound guidelines: Emergency, Point-of-care, and clinical ultrasound guidelines in medicine. Revised April 2023. https://www.acep.org/siteassets/new-pdfs/policy-statements/ultrasound-guidelines--emergency-point-of-care-and-clinical-ultrasound-guidelines-in-medicine.pdf . Accessed 15 June 2023.
Moore CL, Molina AA, Lin H (2006) Ultrasonography in community emergency departments in the United States: access to ultrasonography performed by consultants and status of emergency physician-performed ultrasonography. Ann Emerg Med 47(2):147–153. (PMID: 10.1016/j.annemergmed.2005.08.02316431225)
Lewiss RE, Pearl M, Nomura JT et al (2013) CORD-AEUS: consensus document for the emergency ultrasound milestone project. Acad Emerg Med 20(7):740–745. (PMID: 10.1111/acem.1216423859589)
Amini R, Wyman MT, Hernandez NC et al (2017) Use of emergency ultrasound in Arizona community emergency departments. J Ultrasound Med 36(5):913–921. (PMID: 10.7863/ultra.16.0506428150328)
Boyd JS, LoPresti CM et al (2019) Current use and training needs of point-of-care ultrasound in emergency departments: a National Survey of VA Hospitals. Am J Emerg Med 37(9):1794–1797. (PMID: 10.1016/j.ajem.2019.02.04330878406)
Resop DM, Basrai Z, Boyd JS et al (2023) Current use, training, and barriers in point-of-care ultrasound in emergency departments in 2020: a National Survey of VA hospitals. Am J Emerg Med 63:142–146. (PMID: 10.1016/j.ajem.2022.09.01936182580)
Remskar MH, Theophanous R, Bowman A et al (2023) Current use, training, and barriers of point-of-care ultrasound in anesthesiology: a National Survey of Veterans Affairs Hospitals. J Cardiothorac Vasc Anesth 37(8):1390–1396. (PMID: 10.1053/j.jvca.2023.03.04237120325)
Sanders JL, Noble VE, Raja AS et al (2015) Access to and use of point-of-care ultrasound in the emergency department. West J Emerg Med 16(5):747–752. (PMID: 10.5811/westjem.2015.7.27216265871014644045)
Leask CF, Sandlund M, Skelton DA et al (2019) Framework, principles and recommendations for utilising participatory methodologies in the co-creation and evaluation of public health interventions. Res Involv Engagem 9(5):2. (PMID: 10.1186/s40900-018-0136-9)
Redman S, Greenhalgh T, Adedokun L et al (2021) Co-production of Knowledge Collection Steering Committee. Co-production of knowledge: the future. BMJ. https://doi.org/10.1136/bmj.n434. (PMID: 10.1136/bmj.n434335937537884902)
U.S. Department of Veterans Affairs. Veterans Health Administration. About VHA. https://www.va.gov/health/aboutvha.asp#:~:text=The%20Veterans%20Health%20Administration%20(VHA,Veterans%20enrolled%20in%20the%20VA . Accessed June 15, 2023.
Slattery P, Saeri AK, Bragge P (2020) Research co-design in health: a rapid overview of reviews. Health Res Policy Syst 18(1):17. (PMID: 10.1186/s12961-020-0528-9320467287014755)
Iniesto F, Charitonos K, Littlejohn A (2022) A review of research with co-design methods in health education. Open Educ Stud 4(1):273–295. (PMID: 10.1515/edu-2022-0017)
Raynor DK, Ismail H, Blenkinsopp A et al (2020) Experience-based co-design-Adapting the method for a researcher-initiated study in a multi-site setting. Health Expect 23(3):562–570. (PMID: 10.1111/hex.13028320450877321746)
Hickey G, Brearley S, Coldham T, et al (2018) Guidance on co-producing a research project. Southampton: INVOLVE.
Hill DL, Walter JK, Casas JA et al (2018) The codesign of an interdisciplinary team-based intervention regarding initiating palliative care in pediatric oncology. Support Care Cancer 26(9):3249–3256. (PMID: 296278636379076)
Crowther L, Pearson M, Cummings H et al (2022) Towards codesign in respiratory care: development of an implementation-ready intervention to improve guideline-adherent adult asthma care across primary and secondary care settings (The SENTINEL Project). BMJ Open Respir Res 9(1):e001155. (PMID: 10.1136/bmjresp-2021-001155351729858852749)
Bird M, McGillion M, Chambers EM et al (2021) A generative co-design framework for healthcare innovation: development and application of an end-user engagement framework. Res Involv Engagem. https://doi.org/10.1186/s40900-021-00252-7. (PMID: 10.1186/s40900-021-00252-7336485887923456)
Mohan H, Nandanan K, Mohan R, et al (2019) Case Study on co-design methodology for improved cook stove solutions for rural community in India. 2019 IEEE Region 10 Humanitarian Technology Conference. Depok, Indonesia, Nov 12–14.
Staniszewska S, Brett J, Simera I et al (2017) GRIPP2 reporting checklists: tools to improve reporting of patient and public involvement in research. BMJ 358:j3453. (PMID: 10.1136/bmj.j3453287686295539518)
Schnikkte N, Damewood S (2019) Identifying and overcoming barriers to resident use of point-of-care ultrasound. West J Emerg Med 20(6):918–925. (PMID: 10.5811/westjem.2019.8.43967)
Choi YJ, Jung JY, Kwon H (2017) Effectiveness of ultrasound education in point-of-care ultrasound-assisted physical examinations in an emergency department: a before-and-after study. Medicine. 96(25):e7269. (PMID: 10.1097/MD.0000000000007269286401335484241)
Schott CK, LoPresti CM, Boyd JS et al (2021) Retention of point-of-care ultrasound skills among practicing physicians: findings of the VA National POCUS training program. Am J Med 134(3):391399.e8. (PMID: 10.1016/j.amjmed.2020.08.008)
Blans MJ, Pijl MEJ, Van de Water JM, et al (2020) The implementation of POCUS and POCUS training for residents: the Rinjstate approach. Neth J Med 78(3):116–124.
Brant JA, Orsborn J, Good R et al (2021) Evaluating a longitudinal point-of-care ultrasound (POCUS) curriculum for pediatric residents. BMC Med Educ 21:64. (PMID: 10.1186/s12909-021-02488-z334681387816421)
Butki N, Long J, Butki A, et al (2020) A Novel “Train the Trainer” emergency medicine resident point-of-care ultrasound course: a feasibility study. SMRJ 4(2).
Theophanous RG, Tupetz A, Ragsdale L, et al (2024) A qualitative study of perceived barriers and facilitators to point-of-care ultrasound use among Veterans Affairs Emergency Department providers.
Trischler J, Pervan S, Kelly S et al (2018) The value of codesign: the effect of customer involvement in service design teams. J Serv Res 2(1):75–100. (PMID: 10.1177/1094670517714060)
Palmer VJ, Weavell W, Callander R et al (2019) The Participatory Zeigeist: an explanatory theoretical model of change in an era of coproduction and codesign in healthcare improvement. Med Humanit 45:247257. (PMID: 10.1136/medhum-2017-011398)
Bate P, Robert G (2006) Experience-based design: redesigning the system around the patient to co-designing services with the patient. Qual Saf Health Care 15:307–310. (PMID: 10.1136/qshc.2005.016527170748632565809)
Haun JN, Nazi KM, Chavez M et al (2015) A participatory approach to designing and enhancing integrated health information technology systems for veterans: protocol. JMIR Res Protoc 4(1):e28. (PMID: 10.2196/resprot.3815258033244376141)
LaMonica HM, Davenport TA, Burns J et al (2019) Technology-enabled mental health service reform for open arms - Veterans and families counselling: participatory design study. JMIR Form Res 3(3):e13662. (PMID: 10.2196/13662315389376754687)
Flanagan ME, Plue L, Miller KK et al (2018) A qualitative study of clinical champions in context: clinical champions across three levels of acute care. SAGE Open Med 1(6):2050312118792426. (PMID: 10.1177/2050312118792426)
Moore CL, Molina AA, Lin H (2006) Ultrasonography in community emergency departments in the United States: access to ultrasonography performed by consultants and status of emergency physician-performed ultrasonography. Ann Emerg Med 47(2):147–153. (PMID: 10.1016/j.annemergmed.2005.08.02316431225)
Lewiss RE, Pearl M, Nomura JT et al (2013) CORD-AEUS: consensus document for the emergency ultrasound milestone project. Acad Emerg Med 20(7):740–745. (PMID: 10.1111/acem.1216423859589)
Amini R, Wyman MT, Hernandez NC et al (2017) Use of emergency ultrasound in Arizona community emergency departments. J Ultrasound Med 36(5):913–921. (PMID: 10.7863/ultra.16.0506428150328)
Boyd JS, LoPresti CM et al (2019) Current use and training needs of point-of-care ultrasound in emergency departments: a National Survey of VA Hospitals. Am J Emerg Med 37(9):1794–1797. (PMID: 10.1016/j.ajem.2019.02.04330878406)
Resop DM, Basrai Z, Boyd JS et al (2023) Current use, training, and barriers in point-of-care ultrasound in emergency departments in 2020: a National Survey of VA hospitals. Am J Emerg Med 63:142–146. (PMID: 10.1016/j.ajem.2022.09.01936182580)
Remskar MH, Theophanous R, Bowman A et al (2023) Current use, training, and barriers of point-of-care ultrasound in anesthesiology: a National Survey of Veterans Affairs Hospitals. J Cardiothorac Vasc Anesth 37(8):1390–1396. (PMID: 10.1053/j.jvca.2023.03.04237120325)
Sanders JL, Noble VE, Raja AS et al (2015) Access to and use of point-of-care ultrasound in the emergency department. West J Emerg Med 16(5):747–752. (PMID: 10.5811/westjem.2015.7.27216265871014644045)
Leask CF, Sandlund M, Skelton DA et al (2019) Framework, principles and recommendations for utilising participatory methodologies in the co-creation and evaluation of public health interventions. Res Involv Engagem 9(5):2. (PMID: 10.1186/s40900-018-0136-9)
Redman S, Greenhalgh T, Adedokun L et al (2021) Co-production of Knowledge Collection Steering Committee. Co-production of knowledge: the future. BMJ. https://doi.org/10.1136/bmj.n434. (PMID: 10.1136/bmj.n434335937537884902)
U.S. Department of Veterans Affairs. Veterans Health Administration. About VHA. https://www.va.gov/health/aboutvha.asp#:~:text=The%20Veterans%20Health%20Administration%20(VHA,Veterans%20enrolled%20in%20the%20VA . Accessed June 15, 2023.
Slattery P, Saeri AK, Bragge P (2020) Research co-design in health: a rapid overview of reviews. Health Res Policy Syst 18(1):17. (PMID: 10.1186/s12961-020-0528-9320467287014755)
Iniesto F, Charitonos K, Littlejohn A (2022) A review of research with co-design methods in health education. Open Educ Stud 4(1):273–295. (PMID: 10.1515/edu-2022-0017)
Raynor DK, Ismail H, Blenkinsopp A et al (2020) Experience-based co-design-Adapting the method for a researcher-initiated study in a multi-site setting. Health Expect 23(3):562–570. (PMID: 10.1111/hex.13028320450877321746)
Hickey G, Brearley S, Coldham T, et al (2018) Guidance on co-producing a research project. Southampton: INVOLVE.
Hill DL, Walter JK, Casas JA et al (2018) The codesign of an interdisciplinary team-based intervention regarding initiating palliative care in pediatric oncology. Support Care Cancer 26(9):3249–3256. (PMID: 296278636379076)
Crowther L, Pearson M, Cummings H et al (2022) Towards codesign in respiratory care: development of an implementation-ready intervention to improve guideline-adherent adult asthma care across primary and secondary care settings (The SENTINEL Project). BMJ Open Respir Res 9(1):e001155. (PMID: 10.1136/bmjresp-2021-001155351729858852749)
Bird M, McGillion M, Chambers EM et al (2021) A generative co-design framework for healthcare innovation: development and application of an end-user engagement framework. Res Involv Engagem. https://doi.org/10.1186/s40900-021-00252-7. (PMID: 10.1186/s40900-021-00252-7336485887923456)
Mohan H, Nandanan K, Mohan R, et al (2019) Case Study on co-design methodology for improved cook stove solutions for rural community in India. 2019 IEEE Region 10 Humanitarian Technology Conference. Depok, Indonesia, Nov 12–14.
Staniszewska S, Brett J, Simera I et al (2017) GRIPP2 reporting checklists: tools to improve reporting of patient and public involvement in research. BMJ 358:j3453. (PMID: 10.1136/bmj.j3453287686295539518)
Schnikkte N, Damewood S (2019) Identifying and overcoming barriers to resident use of point-of-care ultrasound. West J Emerg Med 20(6):918–925. (PMID: 10.5811/westjem.2019.8.43967)
Choi YJ, Jung JY, Kwon H (2017) Effectiveness of ultrasound education in point-of-care ultrasound-assisted physical examinations in an emergency department: a before-and-after study. Medicine. 96(25):e7269. (PMID: 10.1097/MD.0000000000007269286401335484241)
Schott CK, LoPresti CM, Boyd JS et al (2021) Retention of point-of-care ultrasound skills among practicing physicians: findings of the VA National POCUS training program. Am J Med 134(3):391399.e8. (PMID: 10.1016/j.amjmed.2020.08.008)
Blans MJ, Pijl MEJ, Van de Water JM, et al (2020) The implementation of POCUS and POCUS training for residents: the Rinjstate approach. Neth J Med 78(3):116–124.
Brant JA, Orsborn J, Good R et al (2021) Evaluating a longitudinal point-of-care ultrasound (POCUS) curriculum for pediatric residents. BMC Med Educ 21:64. (PMID: 10.1186/s12909-021-02488-z334681387816421)
Butki N, Long J, Butki A, et al (2020) A Novel “Train the Trainer” emergency medicine resident point-of-care ultrasound course: a feasibility study. SMRJ 4(2).
Theophanous RG, Tupetz A, Ragsdale L, et al (2024) A qualitative study of perceived barriers and facilitators to point-of-care ultrasound use among Veterans Affairs Emergency Department providers.
Trischler J, Pervan S, Kelly S et al (2018) The value of codesign: the effect of customer involvement in service design teams. J Serv Res 2(1):75–100. (PMID: 10.1177/1094670517714060)
Palmer VJ, Weavell W, Callander R et al (2019) The Participatory Zeigeist: an explanatory theoretical model of change in an era of coproduction and codesign in healthcare improvement. Med Humanit 45:247257. (PMID: 10.1136/medhum-2017-011398)
Bate P, Robert G (2006) Experience-based design: redesigning the system around the patient to co-designing services with the patient. Qual Saf Health Care 15:307–310. (PMID: 10.1136/qshc.2005.016527170748632565809)
Haun JN, Nazi KM, Chavez M et al (2015) A participatory approach to designing and enhancing integrated health information technology systems for veterans: protocol. JMIR Res Protoc 4(1):e28. (PMID: 10.2196/resprot.3815258033244376141)
LaMonica HM, Davenport TA, Burns J et al (2019) Technology-enabled mental health service reform for open arms - Veterans and families counselling: participatory design study. JMIR Form Res 3(3):e13662. (PMID: 10.2196/13662315389376754687)
Flanagan ME, Plue L, Miller KK et al (2018) A qualitative study of clinical champions in context: clinical champions across three levels of acute care. SAGE Open Med 1(6):2050312118792426. (PMID: 10.1177/2050312118792426)
Grant Information:
AG 2020-0000000099 Society for Academic Emergency Medicine
Contributed Indexing:
Keywords: End-user engagement; Experience based co-design; Healthcare innovation; Participatory action research; Point-of-Care ultrasound (POCUS); Veterans Affairs healthcare system
Entry Date(s):
Date Created: 20250425 Date Completed: 20260306 Latest Revision: 20260306
Update Code:
20260306
DOI:
10.1007/s11739-025-03951-1
PMID:
40278961
Database:
MEDLINE
*Further Information*
*Integrating point-of-care ultrasound (POCUS) into patient care requires a multifaceted culture change using a multi-pronged approach. A standardized implementation method is lacking for POCUS program sustainability. We developed a standardized training curriculum and clinical POCUS documentation, archival, and image review process at a single Veterans Affairs Emergency Department (ED). We hypothesized that co-designed development and implementation of the multifaceted POCUS intervention would maximize ED provider uptake and sustainability. Using Participatory Action Research (PAR) and adapted Experience-Based Co-design (EBCD) methods, stakeholders collaboratively co-designed our POCUS intervention to optimize implementation. Using the PRODUCES framework, 12 stakeholder participants (co-creators including study researchers, ultrasound faculty, ED leadership, and ED providers (POCUS end-users)) met in four monthly co-design meetings from July to October 2021 to brainstorm, discuss, refine, and finalize the POCUS intervention and implementation plan. Throughout the co-design process, stakeholders reviewed findings from prior meetings, reflected on successes and failures, and held open discussions on refining and finalizing the proposed POCUS educational and clinical program. By involving stakeholders as co-creators throughout the co-design process, we maximized end-user POCUS enthusiasm, program uptake, and sustained use. This simple, streamlined, and generalizable user-centered co-design method serves as a framework for future POCUS implementation and dissemination plans.
(© 2025. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)*
*Declarations. Conflict of interest: The authors declare that they have no conflict of interest to report. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standard of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments. Informed consent: Informed consent was obtained from the study participants verbally at the beginning of interviews and was otherwise waived by the institutional review board.*