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

Area of Science:

• Emergency Medicine
• Quality Improvement
• Vascular Access

Background:

• Difficult intravenous access (DIVA) is common in the Emergency Department (ED).
• Ultrasound-guided peripheral IV catheter (USGIV) insertion is an effective method for establishing vascular access in DIVA patients.
• A quality improvement program was developed to address DIVA and promote USGIV.

Purpose of the Study:

• To describe a DIVA quality improvement program focused on rapid identification and emergency nurse USGIV training.
• To evaluate the program's impact on the frequency of USGIV use.
• To assess the program's effect on process measures related to patient care quality.

Main Methods:

• Retrospective cohort study of adult patients from September 2018 to September 2020.
• Difference-in-difference analysis to compare ED process measures pre- and post-program implementation.
• Multivariate logistic regression to identify factors associated with difficult IV access.

Main Results:

• USGIV placement frequency more than doubled post-program implementation (606 to 1323 encounters).
• Significant improvements observed in covariate-adjusted ED process measures, including reduced time to CT with contrast, pain medication administration, IV antibiotics, and overall ED length of stay.
• Specific time reductions: CT (4.8h to 4.1h), pain meds (2.4h to 1.8h), IV antibiotics (3.0h to 2.1h), and ED LOS (6.4h to 6.0h).

Conclusions:

• A nurse-focused quality improvement program promoting USGIV for DIVA is associated with increased USGIV utilization.
• The program led to improvements in core ED process measures, indicating enhanced patient care quality.
• USGIV training and implementation can effectively manage DIVA and optimize ED workflow.