Fewer needles in emergency thanks to new program

Australian hospitals are reducing the number of needles patients receive in emergency, in a move that could save the nation’s healthcare system more than $13 million every year.

Researchers at one of the country’s largest hospitals discovered that 30 per cent of cannulas given to emergency department patients were not needed, and in response developed an educational program known as CREDIT.

Royal Brisbane and Women’s Hospital (RBWH) Emergency and Trauma Centre Senior Staff Specialist Professor Louise Cullen said following a three month trial, the number of cannulas inserted was reduced to three in 10 emergency patients.

“In almost all emergency patients cannulas are put in too soon. They’re great to easily give patients fluids and medications or have blood taken, but they aren’t always needed,” Professor Cullen said.

“We don’t know if this is the case at all hospitals, but in another study it was found emergency departments were using only half of the cannulas that were inserted.

“We’re needlessly spending 15 minutes of staff time to put patients through an unnecessary and painful procedure that’s increasing their risk of contracting a blood infection.

In a single-centre, observational study, the team found that before CREDIT, cannulas were inserted in 42 per cent of patients, with 70 per cent being used. The CREDIT campaign reduced the number of PIVCs to 32 per cent (10% decrease), of which 83 per cent were used (12.9% increase).

RBWH Emergency and Trauma Centre Clinical Research Nurse Tracey Hawkins said the key to success in this invention was changing the culture of needles being routine in the admission process.

“Now at every clinical handover, we ask staff to be 80 per cent sure they would use a cannula before they insert one,” Ms Hawkins said.

“Evidence showed us that many of our patients were getting cannulas that were not being used and through our research we realised that there was a culture of the ‘just in case cannula’ involved.

“When you’re in a busy clinical environment and making a lot of decisions you tend to follow a common pattern of behaviour, and we needed to find a way to empower our clinicians to stop and consider the need for the cannula—is it necessary?”

A range of tools were implemented to promote clinical decision making among the staff of the ETC.

“We came at staff with our message from all angles: education and training sessions, visual aids, real-time surveillance and feedback sessions, and change champions who prompted staff throughout their shifts.”

“Any behaviour change is hard and even more so in a clinical setting because we have a natural urge to ‘do something’ to help our patients. It has been a great reminder that part of value-based medical care is preventing unnecessary tests and procedures, and that sometimes we need to practice deliberate clinical inertia—the art of doing nothing as a positive response.”

Emergency Medicine Foundation – Australasia (EMF) Chair, Dr Anthony Bell said hospital emergency departments around the country had expressed interest in the program, with several hospitals in Queensland commencing implementation.

“This research is an example of emergency clinicians seeing an issue and developing a solution,” said Dr Bell.

“By providing dedicated emergency medicine research funding, EMF enabled this team to gather the necessary data to demonstrate their program delivered results, which in a very short space of time looks set to have a national impact.”

EMF awarded the team an $80,000 research grant to trial the program, with funding from Queensland Health, and the Metro North Hospital and Health Service contributed a further $20,000.

In an economic analysis, the RBWH team found the average cost of inserting each cannula at the Hospital was $22.80 and that if the CREDIT program was rolled out nationally, it could potentially save more than $13.7 million dollars each year.

RBWH research team collaborated with the Griffith University Health Economics Unit and the Alliance for Vascular Access Teaching and Research (AVATAR) as well as Monash Medical Centre’s Associate Professor Diana Egerton-Warburton.

To find out more about the CREDIT study, see the January edition of Academic Emergency Medicine or listen to Ms Hawkins’ interview on the Skeptics Guide to Emergency Medicine podcast.

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