The Cannulation Rates in ED Intervention Trial (CREDIT)

This study aims to reduce PIVC use through evaluation of data collected.

Grant ID: EMPJ-310R23-2015

Project Summary

A peripherally inserted intravenous catheter (PIVC) is a small tube placed into a vein to administer medication or fluids. PIVCs are commonly used in Emergency Departments but recent literature suggests that emergency care providers may place PIVCs more often than required; up to 50% remain unused. This places the patient at unnecessary risk of catheter-related infections and is associated with a high financial cost to the healthcare system.

We will conduct a historically controlled trial where observational data will be collected before and after an intervention aimed to reduce PIVC use. Data collected before the intervention will identify 1) how many PIVCs are placed in the Emergency Department and 2) how many PIVCs are used for fluid, medications, contrast or blood products within 24 hours. Data collected after the intervention will identify whether there has been 1) a reduction in the number of PIVC placed in the Emergency Department and 2) a reduction in unused PIVCs.

The proposed intervention will empower emergency physicians, their trainees and the emergency nursing staff to make an informed, evidence-based decision not to insert a PIVC unless clinically indicated. The impact of such practice change will reach far beyond the Royal Brisbane and Women's Hospital as its findings will have the potential to influence practice change in all Queensland Health Emergency Departments. Reducing the rate of unused PIVC in the Emergency Department will reduce the risk of catheter related infections and reduce healthcare costs.

Outcomes

The CREDIT education campaign successfully reduced PIVC insertion in the ED by approximately 10% in the two week trial at the Royal Brisbane and Women's Hospital (RBWH). Education and awareness of the potential complications of PIVC insertion prompted ED staff to consider clinically appropriate PIVC placement and use.

CREDIT is being adopted by emergency departments nationally and has been cited as part of the Choosing Wisely campaign, a Queensland Health initiative.

Dissemination

Hawkins, T., Greenslade, J.H., Suna, J., Williams, J., Rickard, C.M., Jensen, M., Donohue, M., Cho, E., Hise, C.V., Egerton‐Warburton, D. and Cullen, L., 2018. Peripheral intravenous cannula insertion and use in the emergency department: an intervention study. Academic Emergency Medicine, 25(1), pp.26-32.