Outcomes of an innovative evidence-based project: Building a difficult access team in an emergency department

Abstract

<p><strong>Background/Introduction: </strong>Emergency departments across the nation face challenges of longer lengths of stay due to increased volumes and patient acuity.&nbsp;Intravenous (IV) access is vital to emergency care, and a large proportion of patients seen in the Emergency Department have difficult venous access, resulting in patient care delays.&nbsp;Difficult venous access (DVA) is identified as a condition among individuals who most often require 2 or more attempts for successful IV access, leading to an increased length of time needed to obtain IV access, or may require special interventions to establish peripheral IV access.</p> <p><strong>Purpose/Objectives: </strong>The objective of this project was to determine if a dedicated difficult access team will decrease the number of attempts and amount of time for successfully obtaining IV access in difficult venous access patients.</p> <p><strong>&nbsp;Methods: </strong>The intervention included the implementation of a difficult access clinical technician team. The specialized team was initiated as a pilot to determine whether use of a specialized team would decrease number of attempts and amount of time for successfully obtaining IV access in difficult venous access patients. This study included convenience samples of patients visiting the adult emergency department with a provider order to place IV access. We compared the mean number of attempts and time it took for obtaining successful IV access for the pre and post- intervention periods, among two samples.</p> <p><strong>Results: </strong>Prior to the intervention, there were 3.8 (SD 1.18) mean number of attempts for obtaining IV access for (N=52) patients who were identified to have DVA. After the intervention, a mean number of attempts per DVA patient was reported at 1.2 (0.47). A significant difference (<em>p</em>= &lt;0.05; CI 95% 2.25-2.94) was found between the pre intervention and post intervention mean number of successful attempts but no significant reduction in the time it takes to obtain successful IV access among these two samples.</p> <p><strong>Conclusion: </strong>IV access is an essential procedure for the assessment and treatment of patients seeking health care in the emergency department. It important to consider a feasible solution for managing DVA among patients. Our findings suggest that implementation of a dedicated difficult access team can decrease the time and number of attempts necessary for obtaining IV access in individuals with difficult venous access. Further investigation is necessary to determine variables that impact increased time to obtain successful IV access in patients with difficult venous access.</p>