Barriers and Facilitators to Point-of-Care Ultrasound Utilization Among Emergency Medicine Residents and Emergency Nurse Practitioners Following Institutional Training.

Purpose: Point-of-care ultrasound (POCUS) serves as a critical diagnostic tool in emergency medicine; however, a persistent gap remains between competency acquired during training and consistent clinical application. This study sought to identify barriers and facilitators influencing POCUS examination frequency among emergency medicine (EM) residents and emergency nurse practitioners after institutional training, and to examine the association between individual-level factors and the frequency of POCUS examinations. Patients and Methods: This retrospective study was conducted in the Department of Emergency Medicine at Srinagarind Hospital, Khon Kaen University, Thailand, from January 2024 to December 2025. Cohort 1 included 76 providers (16 EM residents and 60 nurse practitioners) who completed institutional POCUS training between January 2024 and December 2025. Data collected included provider characteristics, competency scores, workload, and responses to a 5-point Likert-scale survey assessing perceived barriers and facilitators. Cohort 2 consisted of 2,097 documented, archived POCUS examinations performed by these providers during a standardized 1-month post-training observation period per provider. Associations were evaluated using correlation coefficients and multivariable linear regression. Results: EM residents demonstrated significantly higher competency scores than nurse practitioners (86.3±5.7 vs 78.9±7.4, p=0.002). The most prevalent barriers identified were high workload and time constraints, limited equipment availability, and reduced interpretive confidence. Nurse practitioners expressed greater concern regarding insufficient institutional support (3.88±0.72 vs 3.06±0.89, p=0.001) and medicolegal risk (3.65±0.79 vs 2.94±0.93, p=0.004), whereas residents rated structured feedback more favorably (p=0.012). Multivariable regression identified competency score (adjusted β = 3.97 per 10-point increase, p < 0.001) and provider type (adjusted β = 9.64, p = 0.007) as independently associated with higher documented POCUS examination frequency, while patient volume per shift was negatively associated (adjusted β = -1.89 per 5-patient increase, p = 0.010). Conclusion: The findings indicate that formal training alone may be insufficient to achieve equitable competency or utilization. Additional multi-center studies are required to validate these results. The competency score showed a more consistent association with POCUS examination frequency than other variables examined, suggesting it may represent an important, though not exclusive, factor influencing real-world use. As examination quality, interpretive accuracy, and clinical impact were not assessed in this study, higher frequency should not be interpreted as better implementation.