Nurse-focused ultrasound-guided IV program improves core emergency department process measures

Abstract

Introduction: Ultrasound-guided peripheral IV catheter (USGIV) insertion is as an effective procedure to establish access in patients with difficult intravenous access (DIVA), a condition frequently encountered in the Emergency Department (ED). This study describes a DIVA quality improvement program focusing on rapid identification of DIVA patients and emergency nurse USGIV training and evaluates its impact on overall frequency of USGIV use and process measures related to quality of patient care. Methods: This is a retrospective cohort study of patients over 18 years of age, presenting to a single, tertiary care hospital between September 1, 2018 and September 30, 2020. Difference-in-difference analysis was used to compare ED process measures pre- and post-implementation of the DIVA Program, and multivariate logistic regression was used to identify associations between patient characteristics and difficult IV access. Results: The frequency of ED encounters associated with USGIV placement more than doubled post-implementation of the DIVA Program, rising from 606 to 1323. There were improved covariate-adjusted time estimates of core ED process measures for encounters associated with USGIV placement post-implementation, including decreases in time to CT with contrast from 4.8 h (95% CI = 4.4–5.2) to 4.1 h (95% CI = 3.8–4.4), pain medications from 2.4 h (95% CI = 2.1–2.6) to 1.8 h (95% CI = 1.6–2.0), IV antibiotics from 3.0 h (95% CI = 2.4–3.7) to 2.1 h (95% CI = 1.5–2.6), and ED length of stay from 6.4 h (95% CI = 6.2–6.6) to 6.0 h (95% CI = 5.9–6.2). Conclusion: A nurse-focused quality improvement program focused on teaching and promoting USGIV as a modality for managing difficult IV access was associated with increases in USGIV placement and improvements in core process measures related to quality of patient care.