346 Development of a Difficult Access Team in the Adult Emergency Department Leads to Faster Intravenous Access

Abstract

To determine if the implementation of an Access in Minutes (AiM) team will reduce the IV access order to completion time for difficult venous access (DVA) patients as compared to current practice. Data collection took place at a level one, tertiary care, urban academic medical center that sees approximately 70,000 patients per year, where up to 70% of patients require definitive IV access. In order to obtain baseline data, a multi-disciplinary team composed of physicians, nurses, clinical technicians and administrators evaluated a convenience sample of patients who were deemed to have DVA. This cohort included patients in whom a clinical technician was unable to establish IV access after two attempts, and a different provider was also unsuccessful after two attempts, requiring a physician to obtain definitive access. Characteristics felt to contribute to DVA were recorded, as well as the time that elapsed from when an IV was ordered until the order was completed. After a cohort of patients were identified to demonstrate the need for an AiM team, a dedicated clinical technician was available in the ED as a pilot for patients who were deemed to be DVA. A qualitative and quantitative analysis was performed on pre and post data, as well as determining patient factors that contributed to DVA status. 135 patients were deemed to be DVA over a 5.5-month period. Of these 135 patients, the most common reason for DVA was prior history of multiple attempts (36.3%), IV drug use history (15.56%), and poor skin quality (12.59%). Additional categories were present in relatively equal frequency and included single arm access, dehydration, sick cell history, and obesity. Prior to the implantation of an AiM team, the mean IV order to completion time was 296.9 minutes (N=41, Std. Dev. 265.85). Post-intervention, the mean IV order to completion time was much lower at an average of 182.47 minutes (N=135, Std. Dev. 248.52). Given that the data was skewed to the right in both the pre and post implementation data, a Mann-Whitney U test was applied. A significant difference in distribution of time from order to access completion (in total minutes) between the pre-AiM and post-AiM group was demonstrated (U=3,853, p< 0.0001). Utilizing an AiM team reduced the time to successful IV access for DVA patients. Patients with DVA tended to have similar characteristics, so future considerations include utilizing a predictive tool to determine which patients might qualify as DVA prior to any attempts at access being made. Patients with DVA may be able to be identified earlier in their ED stay to reduce the amount of time and the number of attempts for IV access, which in turn can enhance patient safety and satisfaction.