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Unnecessary intravenous access in the emergency setting
R A Henderson1, D P Thomson, B A Bahrs
1EastCare Transport Program, University Health Systems of Eastern Carolina, Greenville, North Carolina 27835-6028, USA. hendersonra@ecu.campus.mci.net
Objective:
To determine the rate of unnecessary intravenous (IV) access in the emergency setting.
Methods:
Retrospective chart review of all patients who presented to a rural, academic emergency department (ED) for the study period of June 1 through June 10, 1997. Categorical data and elapsed time to treatment are reported significant at p < 0.05.
Results:
1,342 charts were reviewed; of these, 940 patients were enrolled. 402 patients were excluded for: age <18 years, direct admission, or inadequate charting. Emergency medical services (EMS) transported 278 patients and initiated 84 IVs in the field (30%). 90 of the remaining EMS patients had IV access initiated in the ED (32%). 662 patients presented by other means and 175 were given IVs (26%). Of the IVs initiated in the field, 32 (38%) were used, whereas 122 (46%) of the ED-initiated IVs were used. When all data were combined, only 154 (44.0%) of the 349 patients who had IV access obtained received treatment through the IV. The elapsed time to treatment for patients with IVs initiated by EMS but treatment in the ED was 25.9 minutes, which was not different from that for patients who received both IV and treatment in the ED (28.3 minutes).
Conclusions:
A significant percentage of IVs initiated in the emergency setting are used inappropriately. IV access without treatment in the field did not improve elapsed time to treatment once patients arrived to the ED. In an era of diminishing health care budgets, further study and strict examination of the cost-benefit ratio ensure maximal utilization of emergent IV access.