A theory-informed approach to identify barriers to utilising Point-of-Care Ultrasound (POCUS) in practice: from vicious cycles to sustainable solutions.

Point-of-care ultrasound (POCUS) is a vital tool for diagnosis of life-threatening conditions, with broad consensus supporting its integration into medical curricula. Despite evidence of effectiveness of POCUS training, many clinicians do not utilise skills in practice, resulting in missed patient benefits. Research on the barriers to POCUS utilisation remains limited. To address this, we conducted a theory-informed exploratory qualitative case study to investigate the utilisation of Focused Intensive Care Echo (FICE) in a specialist heart and lung hospital. The investigation was framed using situated learning and activity theory. We undertook 28 interviews, three focus groups (N = 27) and two expert discussions. Thematic analysis identified barriers while difference-within-similarity-analysis (Hofmann, 2020) uncovered how these interact to hinder POCUS-utilisation. We demonstrate how barriers preventing trainees from using POCUS interacted with the wider activity system, forming vicious cycles to further hinder use. These vicious cycles related to enthusiasm, opportunity, support, participation, communication and norms that hindered POCUS-use, and manifest as an underlying tension between competing priorities of POCUS training and patient care. We discuss how theoretically re-framing the findings suggests low/medium-resource mechanisms which helped mitigate this tension and overcome the vicious cycles. These facilitative mechanisms could generate scalable and sustainable solutions to support POCUS-training and utilisation.