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Nurse-led PICC insertion: is it cost effective?
1Medical Student, University of Aberdeen.
Insights
Nurses achieved higher patient satisfaction and comparable success rates for peripherally inserted central catheters (PICCs) compared to radiologists, despite higher costs and infection rates in the radiologist group. Ward-based PICC insertion without x-ray screening is likely most cost-effective.
Area of Science:
- Vascular Access Devices
- Healthcare Economics
- Patient Safety
Background:
- Peripherally inserted central catheters (PICCs) offer longer venous access than peripheral cannulas but incur higher initial costs.
- Optimizing PICC insertion practices is crucial for managing patient distress, staff time, and healthcare expenditure.
- Comparing insertion by nurses versus radiologists is essential for cost-effectiveness and patient outcomes.
Purpose of the Study:
- To compare the insertion costs, patient satisfaction, and infection rates of PICCs placed by trained nurses and radiologists.
- To evaluate the overall efficiency and safety of PICC insertion by different healthcare professionals in a district general hospital.
Main Methods:
- A 4-month study (2012-13) at Raigmore Hospital involving questionnaire data and direct observation of PICC insertions.
- Data collected included insertion time, staff involved, consumables, success rates, patient satisfaction (pre- and post-insertion), longevity, infection, and failure rates from patient notes.
Main Results:
- Radiologist insertions were 42% more costly (p<0.01) than nurse insertions.
- Patient satisfaction with pre-insertion explanations was higher in the nurse group.
- The radiologist group exhibited higher insertion success and infection rates.
Conclusions:
- PICC insertion can be safely performed by nurses in a ward-based setting without x-ray screening.
- Ward-based PICC insertion by nurses presents a potentially more cost-effective solution for high-volume services.
- Optimizing staff roles in PICC insertion can improve patient satisfaction and potentially reduce costs.
Aims:
Repeated attempts to cannulate small veins can cause considerable distress for patients and expend substantial staff time. For longer term venous access, a peripherally inserted central catheter (PICC) may be used instead of a peripheral cannula. Previous studies indicate that insertion of a PICC costs three times more than a cannula but the lifespan is substantially longer. This study aimed to compare insertion cost, patient satisfaction, and infection rates of PICCs for the two main staff groups (trained nurses and radiologists) inserting these devices in a district general hospital.
Materials And Methods:
The study took place over 4 months in 2012-13. A questionnaire was attached to all identified PICCs in stock at Raigmore Hospital to collect details of the date of insertion, patient involved, time taken, attendant staff grade and experience level, consumables used and insertion success. The lead author's personal observation of PICC insertion by different staff groups allowed estimation of staff time, costs and success rates. Patient experience and satisfaction was assessed before and after insertion using a patient questionnaire. PICC longevity, infection rates and failures were assessed by review of patient notes.
Results:
The radiologist group had a statistically significant (p< 0.01) increased cost (42%) over the nurse group. Patient satisfaction regarding explanation of treatment before insertion was higher in the nurse group. Insertion success and infection rates were higher in the radiologist group.
Conclusion:
The authors conclude that the majority of PICCs can be safely performed without x-ray screening in a ward-based environment. This is likely to be the most cost-effective solution for large volume services.
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