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Background: People experiencing homelessness (PEH) face disproportionate cardiovascular risk yet encounter significant barriers to heart failure (HF) screening and treatment. Point-of-care ultrasound (POCUS) offers a promising, accessible tool for early HF detection in street medicine settings. The UCLA Mobile Clinic Project (MCP), a student-run clinic serving unsheltered Los Angeles population for the past 26 years, was selected for this intervention given its established patient trust, demonstrated HF screening need, and robust primary care referral infrastructure.

Objectives: To assess physician provider readiness and feasibility of implementing a POCUS-based HF screening protocol within a streetside, student-run clinic serving PEH. 

Design: This multi-phase implementation study was conducted at MCP's weekly streetside clinics in Hollywood, LA. In the development phase, a retrospective chart review of 600 MCP patients established HF screening criteria, and five structured focus groups with physicians and student coordinators informed protocol and referral design. In the training phase, providers (n=5) completed baseline POCUS competency surveys and standardized training — including asynchronous curricula, didactics, and hands-on simulation — while undergraduate caseworkers completed trauma-informed care training. During implementation, patients are screened in triage for HF symptoms and risk factors; those meeting criteria undergo pulmonary (B-lines) and internal jugular vein (IJV) POCUS scans, with referrals to the ED or primary care based on findings and patient-specific barriers. Evaluation is ongoing through provider surveys, iterative feedback cycles, and prospective scan data collection to assess protocol effectiveness.

Impact/Effectiveness: This study demonstrates the feasibility of POCUS-based HF screening in a street medicine setting, with no prior published literature describing this application in PEH. Pre-training provider surveys (n=4) revealed moderate baseline POCUS confidence (mean 3.38–4.00/5 across domains). Following standardized training, post-assessment scores improved across all competency domains, with the largest gains in IJV/fluid overload interpretation (3.38 → 4.75, Δ+1.38) and technical knob and probe skills (3.50 → 4.50, Δ+1.00). All 4 providers correctly identified B-lines and IJV anatomy on image interpretation tasks (100%). Within the first 2 months of rollout, 8 scans were conducted; 2 patients screened positive for fluid overload, with 2 primary care referrals and 2 ED transports facilitated via Lyft. Based on feedback, screening criteria were broadened to include patients with risk factors, even in the absence of active symptoms — lowering barriers to early detection.

Lessons Learned: Provider confidence improved meaningfully across all domains following training, though B-line quantification remained the most challenging skill (cited by 75% of providers). Perceived workflow impact was moderate (mean 2.5/4), consistent with early-stage rollout; qualitative feedback highlighted hands-on training format, real-time expert feedback, and coordinator-driven workflow streamlining as key facilitators. Key implementation challenges included patient privacy, scan eligibility ambiguity, time constraints, and care system navigation. Based on attending feedback, screening criteria were broadened to include patients with risk factors, even in the absence of active symptoms — lowering barriers to early detection.

Summary: This pilot establishes a scalable, equity-driven POCUS-based HF screening model for street medicine, demonstrating measurable improvements in provider confidence and clinical competency following structured training. Future directions include longitudinal tracking of exam completion rates, informed consent patterns, and POCUS-driven changes in clinical management. These findings may inform low-barrier care delivery frameworks for early HF detection among unsheltered populations, addressing critical gaps in healthcare access and reducing health disparities.