Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, United States of America.
Oakland University William Beaumont School of Medicine, Rochester, Michigan, United States of America.
PLoS One. 2024 Oct 1;19(10):e0310676. doi: 10.1371/journal.pone.0310676. eCollection 2024.
Education and training in vascular access is a critical component to delivering quality vascular access care. Given that organizations must invest resources to implement and sustain high-quality vascular access programming, we aimed to demonstrate the cost effectiveness of a program (Operation STICK (OSTICK)) in the emergency department (ED).
This was an observational cohort study conducted at a tertiary care academic center with 120,000 ED visits. Consecutive hospitalized adults with ultrasound-guided (DIVA) and traditionally-placed (non-DIVA) peripheral intravenous catheters (PIVC) in the ED were included in the analysis. Two groups (OSTICK and non-OSTICK) were compared in the analysis: OSTICK PIVCs were inserted by clinicians with formal, standardized training in peripheral venous access while non-OSTICK PIVCs were inserted by staff with basic departmental training in PIVC care. Cost factors included number of procedures, wait time to establish a PIVC, complications, and training. Effect was complication-free PIVC functionality. Multiple linear regressions were used to estimate incremental cost (ΔC), incremental effect (ΔE), and incremental net benefit (INB) of the OSTICK program.
From 10/1/2022 thru 3/31/2023, 21,259 PIVCs including 1681 OSTICK and 19,578 non-OSTICK PIVCs were included in the analysis. Average age was 64.8 and 53.7% were female. The estimate of incremental cost (ΔC) for each patient was -$83.175 (95% CI: -$103.953 to -$62.398; p<0.001), indicating that the OSTICK group saves money compared to the non-OSTICK group. The OSTICK group is also more effective at increasing the proportion of catheter dwell time relative to hospital length of stay (ΔE), with an estimate of 0.037 (95% CI: 0.016 to 0.059; p<0.001), compared to those in the non-OSTICK group. The estimated incremental cost-effectiveness ratio (ICER) for the OSTICK group compared with the non-OSTICK group was -$221.964 (95% CI: -$177.400 to -$381.716) per ten percentage points of PIVC dwell time to hospital length of stay increase.
Strategic investment in vascular access education and training can yield impressive financial returns while simultaneously enhancing vascular access outcomes. It is imperative for organizations to recognize the significant impact of such initiatives and prioritize the implementation of comprehensive programs.
血管通路的教育和培训是提供高质量血管通路护理的关键组成部分。鉴于组织必须投入资源来实施和维持高质量的血管通路计划，我们旨在展示一个项目（OSTICK）在急诊科的成本效益。
这是一项在一家三级护理学术中心进行的观察性队列研究，共有 120000 次急诊科就诊。在急诊科，连续纳入接受超声引导（DIVA）和传统放置（非-DIVA）外周静脉置管（PIVC）的住院成年患者进行分析。在分析中比较了两组（OSTICK 和非-OSTICK）：OSTICK PIVC 由接受外周静脉通路标准化培训的临床医生插入，而非-OSTICK PIVC 由接受 PIVC 护理基础部门培训的工作人员插入。成本因素包括手术次数、建立 PIVC 的等待时间、并发症和培训。效果是无并发症的 PIVC 功能。使用多元线性回归估计 OSTICK 计划的增量成本（ΔC）、增量效果（ΔE）和增量净效益（INB）。
从 2022 年 10 月 1 日至 2023 年 3 月 31 日，纳入了 21259 例 PIVC，包括 1681 例 OSTICK 和 19578 例非-OSTICK PIVC。平均年龄为 64.8 岁，53.7%为女性。每位患者的增量成本（ΔC）估计为-83.175 美元（95%CI：-103.953 美元至-62.398 美元；p<0.001），这表明 OSTICK 组比非-OSTICK 组省钱。OSTICK 组在增加导管留置时间与住院时间的比例方面也更有效（ΔE），估计为 0.037（95%CI：0.016 至 0.059；p<0.001），而在非-OSTICK 组。OSTICK 组与非-OSTICK 组的增量成本效益比（ICER）估计为每增加 10%PIVC 留置时间至住院时间的成本为-221.964 美元（95%CI：-177.400 美元至-381.716 美元）。
战略投资于血管通路教育和培训可以带来令人印象深刻的财务回报，同时提高血管通路的效果。组织必须认识到这些举措的重大影响，并优先实施全面的计划。
