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Nudging to select single-lumen over multiple-lumen peripherally inserted central catheters (PICCs) in a large safety net system

Published online by Cambridge University Press:  24 March 2023

Daniel Alaiev Open the ORCID record for Daniel Alaiev [Opens in a new window] ,
Mona Krouss ,
Sigal Israilov ,
Lara Musser ,
Joseph Talledo Open the ORCID record for Joseph Talledo [Opens in a new window] ,
Nessreen Mestari ,
Amit Uppal ,
Theresa Madaline ,
Gabriel Cohen Open the ORCID record for Gabriel Cohen [Opens in a new window]  and
Nathaniel Bravo
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Daniel Alaiev
Affiliation:
Department of Quality and Safety, New York City Health + Hospitals, New York, New York
Mona Krouss
Affiliation:
Department of Quality and Safety, New York City Health + Hospitals, New York, New York Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
Sigal Israilov
Affiliation:
Department of Anesthesia, Icahn School of Medicine at Mount Sinai, New York, New York
Lara Musser
Affiliation:
Department of Emergency Medicine, NYC Health + Hospitals/Jacobi, The Bronx, New York
Joseph Talledo
Affiliation:
Department of Quality and Safety, New York City Health + Hospitals, New York, New York
Nessreen Mestari
Affiliation:
Department of Quality and Safety, New York City Health + Hospitals, New York, New York
Amit Uppal
Affiliation:
Department of Medicine, NYC Health + Hospitals/Bellevue, New York, New York
Theresa Madaline
Affiliation:
Department of Quality and Safety, NYC Health + Hospitals/Coney Island, Brooklyn, New York
Gabriel Cohen
Affiliation:
Department of Population Health, NYC Health + Hospitals, New York, New York
Nathaniel Bravo
Affiliation:
Department of Infection Control and Prevention, NYC Health + Hospitals/Queens, Queens, New York
Marialeah Cervantes
Affiliation:
Department of Infection Control and Prevention, NYC Health + Hospitals/Queens, Queens, New York
Daniel Contractor
Affiliation:
Department of Radiology, NYC Health + Hospitals/Queens, Queens, New York
Peter Alacron Manchego
Affiliation:
Department of Quality and Safety, New York City Health + Hospitals, New York, New York Department of Pediatrics, NYC Health + Hospitals/Kings County, Brooklyn, New York
Komal Chandra
Affiliation:
Department of Quality and Safety, New York City Health + Hospitals, New York, New York
Milana Zaurova
Affiliation:
Department of Quality and Safety, New York City Health + Hospitals, New York, New York Department of Emergency Medicine, Icahn School of Medicine, New York, New York
Surafel Tsega
Affiliation:
Department of Quality and Safety, New York City Health + Hospitals, New York, New York
Hyung J. Cho*
Affiliation:
Department of Quality and Safety, Brigham and Women’s Hospital, Boston, Massachusetts
*
Author for correspondence: Hyung J. Cho, Email: [email protected]
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Abstract

Background:

Peripherally inserted central catheters (PICCs) are increasingly used for vascular access in inpatient settings. Compared to multilumen PICCs, single-lumen PICCs carry a lower rate of complications, including central-line–associated bloodstream infection and thrombosis. Despite this, multilumen PICCs are still overused.

Methods:

This quality improvement initiative was implemented across 11 hospitals at New York City Health + Hospitals safety net system. The electronic health record (EHR) interventional radiology or vascular access team consultation orders were modified to allow for lumen choice, with default selection to a single-lumen PICC.

Results:

Average single-lumen PICC utilization increased by 25.5%, from 44.4% to 69.9% (P < .001). CLABSI rates had a nonsignificant reduction by 26.7% from 2.44 to 1.79 infections per month (P = .255). Among provider types in the postintervention period, single-lumen PICC utilization ranged from 67.7% for advanced practice providers to 82.4%–94.6% for physicians. Among provider specialties, utilization ranged from 31.8% for neurology to 97.7% for orthopedics. Additionally, there was large variation in pre- and postintervention differences in utilization by hospital.

Conclusions:

We successfully increased single-lumen PICC utilization across all 11 safety net hospitals. This expands on previous work on improving single-lumen PICC use and use of default nudges in large, resource-limited settings. Further study is needed to examine variation among provider types, specialties, and hospitals.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 9 , September 2023 , pp. 1381 - 1385
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

Climo, M, Diekema, D, Warren, DK, et al. Prevalence of the use of central venous access devices within and outside of the intensive care unit: results of a survey among hospitals in the prevention epicenter program of the Centers for Disease Control and Prevention. Infect Control Hosp Epidemiol 2003;24:942–945.CrossRefGoogle ScholarPubMed
Chopra, V, Flanders, SA, Saint, S, et al. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): results from a multispecialty panel using the RAND/UCLA appropriateness method. Ann Intern Med 2015;163 suppl 6:S1–S40.CrossRefGoogle Scholar
McMahon, LF Jr, Beyth, RJ, Burger, A, et al. Enhancing patient-centered care: SGIM and choosing wisely. J Gen Intern Med 2014;29:432–433.CrossRefGoogle ScholarPubMed
Bozaan, D, Skicki, D, Brancaccio, A, et al. Less lumens-less risk: a pilot intervention to increase the use of single-lumen peripherally inserted central catheters. J Hosp Med 2019;14:42–46.CrossRefGoogle Scholar
Chopra, V, Ratz, D, Kuhn, L, Lopus, T, Chenoweth, C, Krein, S. PICC-associated bloodstream infections: prevalence, patterns, and predictors. Am J Med 2014;127:319–528.10.1016/j.amjmed.2014.01.001CrossRefGoogle ScholarPubMed
Chopra, V, Kaatz, S, Grant, P, et al. Risk of venous thromboembolism following peripherally inserted central catheter exchange: an analysis of 23,000 hospitalized patients. Am J Med 2018;131:651–660.10.1016/j.amjmed.2018.01.017CrossRefGoogle ScholarPubMed
Chopra, V, Flanders, SA, Saint, S. The problem with peripherally inserted central catheters. JAMA 2012;308:1527–1528.CrossRefGoogle ScholarPubMed
O’Brien, J, Paquet, F, Lindsay, R, Valenti, D. Insertion of PICCs with minimum number of lumens reduces complications and costs. J Am Coll Radiol 2013;10:864–848.CrossRefGoogle ScholarPubMed
Lam, PW, Volling, C, Chan, T, et al. Impact of defaulting to single-lumen peripherally inserted central catheters on patient outcomes: an interrupted time-series study. Clin Infect Dis 2018;67:954–957.CrossRefGoogle ScholarPubMed
Last, BS, Buttenheim, AM, Timon, CE, Mitra, N, Beidas, RS. Systematic review of clinician-directed nudges in healthcare contexts. BMJ Open 2021;11:e048801.CrossRefGoogle ScholarPubMed
13. Soong, C, Shojania, KG. Education as a low-value improvement intervention: often necessary but rarely sufficient. BMJ Qual Saf 2020;29:353–357.CrossRefGoogle Scholar
Roman, BR, Yang, A, Masciale, J, Korenstein, D. Association of attitudes regarding overuse of inpatient laboratory testing with healthcare provider type. JAMA Intern Med 2017;177:1205–1207.10.1001/jamainternmed.2017.1634CrossRefGoogle Scholar
Cipher, DJ, Hooker, RS, Guerra, P. Prescribing trends by nurse practitioners and physician assistants in the United States. J Am Acad Nurse Pract 2006;18:291–296.CrossRefGoogle ScholarPubMed
Hughes, DR, Jiang, M, Duszak, R Jr A comparison of diagnostic imaging ordering patterns between advanced practice clinicians and primary care physicians following office-based evaluation and management visits. JAMA Intern Med 2015;175:101–107.CrossRefGoogle ScholarPubMed
Lyles, CR, Handley, MA, Ackerman, SL, et al. Innovative implementation studies conducted in US safety-net healthcare settings: a systematic review. Am J Med Qual 2019;34:293–306.CrossRefGoogle ScholarPubMed
Stinnett-Donnelly, JM, Stevens, PG, Hood, VL. Developing a high value care programme from the bottom up: a programme of faculty-resident improvement projects targeting harmful or unnecessary care. BMJ Qual Saf 2016;25:901–908.CrossRefGoogle ScholarPubMed
Fakih, MG, Bufalino, A, Sturm, L, et al. Coronavirus disease 2019 (COVID-19) pandemic, central-line–associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI): the urgent need to refocus on hardwiring prevention efforts. Infect Control Hosp Epidemiol 2022;43:26–31.CrossRefGoogle ScholarPubMed
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