Abstract
Point-of-care ultrasound is a transformative tool in anesthesiology. It provides real-time bedside imaging that enhances diagnostics, accelerates decision-making, and improves perioperative safety. Despite clear benefits, routine integration remains limited due to financial, educational, and organizational barriers.
Strategies focus on affordable device procurement, structured training with standardized curricula, and faculty development. Change is driven by integration into residency programs, local ambassadors, and pilot projects, while institutional policies on credentialing, quality assurance, and medicolegal protection safeguard consistent practice. Future developments such as handheld devices, AI-assisted interpretation, tele-ultrasonography, and electronic health record integration promise broader accessibility and improved quality control. By systematically addressing barriers, point-of-care ultrasound can become embedded in perioperative workflows as a standard of care, ultimately improving patient outcomes and advancing modern perioperative medicine. This review outlines a structured framework for implementing point-of-care ultrasound in anesthesiology.
1
Introduction
Point-of-care ultrasound (PoCUS) is a rapidly advancing diagnostic bedside imaging tool that has transformed anesthesiology and perioperative medicine. It complements the physical examination and provides a rapid, non-invasive method to answer specific clinical questions. By providing real-time, goal-directed imaging at the patient’s bedside, PoCUS enhances clinical decision-making, improves diagnostic accuracy and expedites patient care.
Despite its benefits and growing adoption, challenges to widespread implementation remain. There is a need for standardized training, competency frameworks, institutional support, and protocols to facilitate PoCUS embedding into routine perioperative practice . Therefore, residency programs and professional societies have begun to establish training requirements and guidelines. The biggest challenge remains closing the gap between potential and reality: time, funding and culture all shape whether or not new techniques are truly adopted.
This review presents a framework for the implementation of PoCUS in anesthesiology departments and training of novices and experienced practitioners. The role of novel technologies, such as artificial intelligence, and approaches to maintain quality and competency are also discussed. Finally, we address barriers for implementation of PoCUS in daily practice and offer possible solutions.
2
Implementation
Implementing PoCUS successfully in the workflow of an anesthesiology department requires a structured approach to training and education. Keys to success include baseline knowledge and needs assessment of novices, the design of a curriculum and protocols, institutional support and the leverage of new technologies for training .
2.1
Training & education
Current PoCUS education is structured around a multimodal framework that integrates bedside hands-on training, simulation-based practice, workshops, and digital learning. Bedside training remains pivotal. It allows hands-on experience under expert supervision, the integration of sonographic findings into real-time perioperative decision-making and the development of practical skills . Simulation-based training complements bedside education by offering a controlled environment in which trainees can repeatedly practice probe handling, image acquisition and interpretation without patient risk. High-fidelity simulators enable deliberate practice, including exposure to infrequently encountered or complex scenarios . Similarly, workshops provide focused sessions that combine didactic instruction with guided scanning practice, often led by expert faculty. These are effective for both introducing new applications and consolidating core competencies . Digital learning platforms are increasingly incorporated into curricula and provide flexible access to tutorials, instructional videos, interactive modules and case-based exercises. While these tools cannot substitute for hands-on experience, they reinforce theoretical knowledge, allow self-paced learning and serve as valuable pre- and post-training resources .
Despite the educational potential of this approach, there is currently no universally accepted standard for PoCUS training or competency assessment in anesthesiology. This poses significant challenges for both the integration of PoCUS into residency curricula and the establishment of benchmarks for clinical proficiency among practicing anesthesiologists. Internationally, only the Royal College of Anaesthetists in the UK has a nationally approved PoCUS curriculum for anesthesia, while in the US and Canada, national-level postgraduate certification is generally limited to advanced echocardiography. Recent position statements by the American Society of Anesthesiologists (ASA) and other international institutes underscore the importance of structured training and have advocated for the incorporation of PoCUS into formal curricula, with mandatory competency requirements for both residents in training and practicing anesthesiologists . The European Society of Regional Anesthesia (ESRA) has very recently established a scientific committee, dedicated to the qualitative structuring of PoCUS education and organization of a dedicated European PoCUS congress.
2.2
Curriculum integration & mentorship
Before rolling out a PoCUS training program, it is valuable to gauge baseline knowledge, skills and perceptions within the target group. In an anesthesiology department, there are typically two cohorts to consider: novice (residents/fellows) and attending anesthesiologists, each with distinct learning needs and starting skill levels.
2.2.1
Anesthesiology trainees
Many residency programs incorporate PoCUS education, though scope and depth vary considerably ,. Training begins with baseline assessments—written tests, surveys and hands-on evaluations—that identify learning gaps and common misconceptions. Structured clinical examinations (OSCEs) and simulation scenarios (e.g., shock management on high-fidelity manikins) assess both psychomotor skills and the integration of PoCUS into clinical decision-making ,,.
A structured, longitudinal curriculum spans basic, medium and advanced levels. Basic training emphasizes ultrasound physics, machine operation and image acquisition ,. Medium-level training adds supervised scanning and clinical integration, reinforced by simulation on phantoms or volunteers before supervised patient practice. Competency milestones and standardized tools guide progression . Continuous feedback through peer and faculty review further consolidates learning. Archiving scans for structured evaluation and debriefing fosters reflection, deliberate practice and steady improvement.
2.2.2
Novice attending anesthesiologists
Experienced anesthesiologists who are new to PoCUS, must focus less on foundational technical instruction and more on evaluation of prior exposure, clinical attitudes and perceived barriers. Establishing this baseline is essential for tailoring training.
A first step is the use of pre-training surveys to document current ultrasound practices, previous exposure and perceptions of PoCUS. Some anesthesiologists may routinely employ ultrasound for vascular access but have limited experience with diagnostic applications, while others may have attended workshops without subsequent clinical use. Surveys can also uncover perceived barriers—such as limited time, lack of equipment, or skepticism about clinical utility—that must be addressed ,. Focused discussions and workshops provide further insight into clinical needs. Brainstorming scenarios such as assessing intravascular volume status during prolonged surgeries or postoperative respiratory compromise, can highlight the direct relevance of PoCUS for daily practice ,. Additionally, case-based assessments offer a structured means of identifying both interest and knowledge gaps. Scenarios such as “the hypotensive postoperative patient” encourages clinicians to articulate their diagnostic and management strategies. A lack of reference to cardiac or abdominal PoCUS in these discussions may signal missed opportunities, while errors in interpretation highlight areas where targeted instruction is needed . Importantly, baseline assessments often reveal that even seasoned clinicians demonstrate strong interest in PoCUS once its potential value is contextualized. A 2020 survey of Veterans Affairs anesthesiology departments found that although 83 % reported some use of PoCUS, while lack of formal training remained the most significant barrier to broader adoption .
2.2.3
Mentorship and train-the-trainer
Sustaining PoCUS expertise within a department requires the cultivation of in-house educators. A “train-the-trainer” approach ensures that a core group attains certification and educational skills, which enables them to teach, supervise and assess colleagues locally. Such programs not only increase departmental capacity but also allow for customization of training to the institution’s specific clinical needs . Complementary mentorship models pair less experienced users with seasoned PoCUS practitioners.
2.3
Institutional and professional support
A central component of strategy implementation is the systematic documentation of PoCUS findings within the electronic health record (EHR). Modern ultrasound machines often interface directly with hospital networks, allowing seamless archiving of images, clips and structured reports into the patient’s chart. This ensures continuity of care, facilitates auditing and enables quality improvement and research initiatives. Robust image management systems also support medicolegal protection and interprofessional communication .
Equally important to the adoption of PoCUS is the integration of regular case discussions into departmental workflows. These may include morbidity and mortality conferences, dedicated “PoCUS rounds”, or weekly image review sessions. This provides the discussion of challenging cases, reinforces proper technique and highlights exemplary use. Even small-scale chat groups, for sharing anonymous images and discussing ad hoc questions, can be beneficial.
2.4
Technological innovations
The implementation of PoCUS is increasingly shaped by technological innovations that enhance accessibility, efficiency and patient safety. These are summarized in Table 1 . Handheld ultrasound devices are becoming smaller and more portable and affordable. This allows rapid bedside imaging in operating rooms and resource-limited environments. AI-assisted interpretation further strengthens implementation through real-time guidance on probe positioning, automatically identification of anatomical structures and flagging of abnormalities. These functions reduce operator dependency, minimize cognitive load and mitigate diagnostic errors for both trainees and experienced clinicians ,. Tele-ultrasonography allows remote supervision and consultation. This enables experts to provide real-time feedback across geographically dispersed or resource-limited settings ,. Technological integration with EHRs and advanced data analytics may enable longitudinal tracking of findings, support clinical research and facilitate quality improvement initiatives . Particularly in in low-resource environments, the combination of handheld devices, AI and tele-ultrasonography can democratize access, enhance patient safety and strengthen decision-making ,.
Table 1
Future of implementing PoCUS.
| Technologies/approaches | References | Key contributions |
|---|---|---|
| Handheld Ultrasound Devices |
|
|
| AI-assisted Interpretation | , |
|
| Tele-ultrasonography | , |
|
| Integration with EHR & Data Analytics | , |
|
| Expanded Clinical Role | ,, |
|
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