Tracey Hawkins1, Jaimi H Greenslade1,2, Jessica Suna1,3, Julian Williams1,2, Claire M Rickard4, Matthew Jensen1,5, Maria Donohue6, Elizabeth Cho2, Christopher Van Hise2, Diana Egerton-Warburton7,8, Louise Cullen1,2,9. 1. Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. 2. School of Medicine, University of Queensland, Herston, Queensland, Australia. 3. School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia. 4. Alliance for Vascular Access Teaching and Research Griffith University, Nathan, Queensland, Australia. 5. Emergency Department, Sentara Norfolk General Hospital, Norfolk, VA. 6. Centre for Applied Health Economics, Griffith University, Mount Gravatt, Queensland, Australia. 7. School of Clinical Sciences, Monash Health, Monash University, Melbourne, Victoria, Australia. 8. Emergency Department, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia. 9. Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
Abstract
OBJECTIVES: The objective was to examine cannulation practice and effectiveness of a multimodal intervention to reduce peripheral intravenous cannula (PIVC) insertion in emergency department (ED) patients. METHODS: A prospective before and after study and cost analysis was conducted at a single tertiary ED in Australia. Data were collected 24 hours a day for 2 weeks pre- and post implementation of a multimodal intervention. PIVC placement and utilization within 24 hours were evaluated in all eligible patients. RESULTS: A total of 4,173 participants were included in the analysis. PIVCs were placed in 42.1% of patients' pre intervention and 32.4% post intervention, a reduction of 9.8% (95% confidence interval [CI] = 6.8 to -12.72%). PIVC usage within 24 hours of admission was 70.5% pre intervention and 83.4% post intervention, an increase of 12.9% (95% CI = 8.8% to 17.0%). Sixty-six patients were observed in the ED for cost analysis. The mean time per PIVC insertion was 15.3 (95% CI = 12.6 to 17.9) minutes. PIVC insertion cost, including staff time and consumables per participant, was A$22.79 (95% CI = A$19.35 to A$26.23). CONCLUSIONS: The intervention reduced PIVC placement in the ED and increased the percentage of PIVCs placed that were used. This program benefits patients and health services alike, with potential for large cost savings.
OBJECTIVES: The objective was to examine cannulation practice and effectiveness of a multimodal intervention to reduce peripheral intravenous cannula (PIVC) insertion in emergency department (ED) patients. METHODS: A prospective before and after study and cost analysis was conducted at a single tertiary ED in Australia. Data were collected 24 hours a day for 2 weeks pre- and post implementation of a multimodal intervention. PIVC placement and utilization within 24 hours were evaluated in all eligible patients. RESULTS: A total of 4,173 participants were included in the analysis. PIVCs were placed in 42.1% of patients' pre intervention and 32.4% post intervention, a reduction of 9.8% (95% confidence interval [CI] = 6.8 to -12.72%). PIVC usage within 24 hours of admission was 70.5% pre intervention and 83.4% post intervention, an increase of 12.9% (95% CI = 8.8% to 17.0%). Sixty-six patients were observed in the ED for cost analysis. The mean time per PIVC insertion was 15.3 (95% CI = 12.6 to 17.9) minutes. PIVC insertion cost, including staff time and consumables per participant, was A$22.79 (95% CI = A$19.35 to A$26.23). CONCLUSIONS: The intervention reduced PIVC placement in the ED and increased the percentage of PIVCs placed that were used. This program benefits patients and health services alike, with potential for large cost savings.
Authors: Peter J Carr; James C R Rippey; Marie L Cooke; Niall S Higgins; Michelle L Trevenen; Aileen Foale; Gerben Keijzers; Claire M Rickard Journal: PLoS One Date: 2019-03-22 Impact factor: 3.240