Abstract
Objective: Ultrasound (US) guidance for procedures is a well-established adjunct that improves the quality of patient care. Specifically, we assess the impact of nurse performed ultrasound-guided peripheral IV (USGPIV) placement on patient satisfaction with the procedure. Methods: We performed a randomized, prospective controlled study. 10 emergency department (ED) nurses were trained on USGPIVs which included a didactic and supervised placement of 10 US-guided IVs on live subjects. Another cohort of 10 ED nurses received a didactic on using traditional techniques to obtain IVs on difficult vascular access patients. Adult patients were enrolled based on strict inclusion criteria which identified them as having difficult vascular access. Once enrolled, the subjects were randomized into either the US-guided arm or the standard of care (SOC) arm, where the designated study trained nurses carried out peripheral IV placement. If the study nurse failed at IV placement, then a rescue IV was attempted by a non-study provider. The study was stopped once an IV was successfully placed. The patient was given a brief verbal survey to rate their experience from 1-10 (1 was poor and 10 was excellent) regarding the IV technique used by the study nurse. Results: 124 subjects were enrolled and randomized. 62 patients remained in the US-guided study arm and 53 patients in the SOC arm (2 were excluded due to lack of study nurse availability, and 7 patients were lost to followup). The median patient satisfaction in the US-guided group was 10 versus 8 for the SOC arm (p=0.04) Conclusion: Our study demonstrated that patient satisfaction is enhanced when nurses utilize the US-guided approach compared to the SOC palpation technique to establish an IV in difficult access patients. We recommend that nursing staff incorporate this method to IV access in difficult patients to enhance the quality of their patient care experience.
Highlights
Patient satisfaction is a valued and highly sought after predictor of quality of care in the emergency department [1,2]
A total of 124 patients were enrolled and randomized into the study. 62 patients remained in the US-guided study arm and 53 patients in the standard of care (SOC) arm (2 were excluded due to lack of study nurse availability, and 7 patients were lost to follow-up)
When comparing our patient demographic there was no significant differences in age, gender, obesity defined as body mass index (BMI) ≥ 30, history of IVDA, history of ESRD, history of sickle cell disease, heart rate, mean arterial pressure
Summary
Patient satisfaction is a valued and highly sought after predictor of quality of care in the emergency department [1,2]. Since 2007 the Centers for Medicare and Medicaid Services (CMS) has tied portions of hospital reimbursement to quality measures based on how patients rate their hospital experience on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey [3,4]. There are numerous factors that weigh into a patient’s satisfaction of their experience in the ED, both interpersonal and technical. A survey of 618 ED patients by Rhee et al demonstrated that nurse technical performance corresponded significantly with overall patient satisfaction [5]. Successful IV access facilitates patient care, allowing for the administration of lifesaving medications, fluids and antibiotics. Despite the regularity in which nurses place IVs, sometimes this fundamental intervention can be difficult to achieve in a subset of patients known to have poor vascular access
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