Table 2.

Point-of-care ultrasound risk and mitigation strategies by programmatic infrastructural element

Infrastructural element	Risk	Mitigation strategy	Challenges to mitigation
Technology and equipment	Direct harm to patient from ultrasound and related equipment	Embed as knowledge objectives within educational processes	Limited knowledge of current standards and human data on actual risk
Training	Incompetent in knowledge, psychomotor and/or interpretative educational domains	Development of initial and longitudinal specialty-specific training	Lack of POCUS educational experts No standardized educational curriculum No definition or method of measuring competency
Documentation	Absent or insufficient documentation resulting in a loss of important information from POCUS	Development of POCUS application-specific documentation templates for inclusion in the medical record	Current differences in documentation practice between and within institutions (e.g., paper versus electronic) Identification of appropriate person to interpret and document results
Image storage	Absent or insufficient image storage capabilities resulting in a loss of review capabilities for initial interpretation or longitudinal assessment of changing physiologies	Development of a local POCUS image storage solution	Solutions may not be technologically available in a local clinical environment Storage solutions external to a hospital system (e.g., “cloud-basedˮ) may not be linked to a medical record and may not be viewable to other clinicians
Quality assurance	A lack of a review processes and/or a review process led by unqualified individuals results in the clinical translation of inadequate POCUS skills integrated in patient care	Development of a quality assurance process providing timely feedback to providers across educational domains led by appropriate specialists	Specialists for oversight likely found in other specialties, particularly in the early phases of POCUS program development No definition of “specialistˮ in many POCUS applications Significant time and effort to build multidisciplinary team for the review of images and to create feedback mechanisms
Processes to define and confirm competency (e.g., credentialing)	Absent institutional or national processes for clinical provider integration of POCUS in patient care	Institutional or national POCUS credentialing or certification processes resulting in clinical privileges for providers completing POCUS training	Requires many of the above elements to be in place or actively in development Resistance from administrators with little knowledge of POCUS

The development of programmatic infrastructural elements embedded with risk mitigation strategies likely results in a symbiotic reduction of overall risk given their obvious interdependence with one another