Improving PICC use and outcomes in hospitalised patients: an interrupted time series study using MAGIC criteria
| Autor: | Scott A. Flanders, Yvonne Calleja, Vineet Chopra, Ashley Snyder, Rama Thyagarajan, Mary A.M. Rogers, Lakshmi Swaminathan, Priscila Bercea |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Michigan medicine.medical_specialty Pediatrics Quality management 030204 cardiovascular system & hematology Peripherally inserted central catheter 03 medical and health sciences symbols.namesake 0302 clinical medicine Intravenous catheter Catheterization Peripheral medicine Humans Poisson Distribution 030212 general & internal medicine Poisson regression Clinical care Aged Aged 80 and over business.industry Health Policy Healthcare quality improvement Interrupted time series Interrupted Time Series Analysis Middle Aged Quality Improvement Hospital medicine Hospitalization Emergency medicine symbols Female business |
| Zdroj: | BMJ Quality & Safety. 27:271-278 |
| ISSN: | 2044-5423 2044-5415 |
| DOI: | 10.1136/bmjqs-2017-007342 |
| Popis: | BackgroundAlthough important in clinical care, reports of inappropriate peripherally inserted central catheter (PICC) use are growing.ObjectiveTo test whether implementation of the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) can improve PICC use and patient outcomes.DesignQuasi-experimental, interrupted time series design at one study site with nine contemporaneous external controls.SettingTen hospitals participating in a state-wide quality collaborative from 1 August 2014 to 31 July 2016.Patients963 hospitalised patients who received a PICC at the study site vs 6613 patients at nine control sites.InterventionA multimodal intervention (tool, training, electronic changes, education) derived from MAGIC.MeasurementsAppropriateness of PICC use and rates of PICC-associated complications. Segmented Poisson regression was used for analyses.ResultsAbsolute rates of inappropriate PICC use decreased substantially at the study site versus controls (91.3% to 65.3% (−26.0%) vs 72.2% to 69.6% (−2.6%); PLimitationsNon-randomised design limits inference; the most effective component of the multimodal intervention is unknown; effects following implementation were modest.ConclusionsIn a multihospital quality improvement project, implementation of MAGIC improved PICC appropriateness and reduced complications to a modest extent. Given the size and resources required for this study, future work should consider cost-to-benefit ratio of similar approaches. |
| Databáze: | OpenAIRE |
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