REDUCTION OF UNNECESSARY INTRAVENOUS CATHETER USE - INTERNAL-MEDICINEHOUSE STAFF PARTICIPATE IN A SUCCESSFUL QUALITY IMPROVEMENT PROJECT

Background: We had previously observed that a large proportion of peri pheral intravenous (IV) catheters placed in patients on a regular medi cal ward at our hospital were unnecessary. We conducted the current st udy to assess the effect of a quality improvement project led by medic ine house staff on the prevalence of unnecessary peripheral IV cathete rs (those without any therapeutic use, referred to as idle). Methods: All patients on four regular-care medical wards of a large university- affiliated veterans hospital were included in the study. The proportio n of IV catheter episodes in which catheters were idle 2 or more conse cutive days (idle episodes) and the proportion of patients exposed to an idle catheter episode were determined by direct observation, chart review, and patient interview before and after a multidisciplinary qua lity improvement task force defined guidelines for appropriate IV cath eter use and made recommendations for hospital policy changes related to IV catheter use. Results: The proportion of all IV catheter episode s that were idle catheter episodes decreased significantly after the i ntervention (42% before vs 29% after, P<.01),as did the proportion of patients with an IV catheter who had at least one idle IV catheter eip sode (43% vs 27%, P<.001). Conclusions: This quality improvement effor t successfully reduced unnecessary IV catheter use. We suspect that ho use-staff involvement in the intervention was critical. We encourage o ther academic medical centers to involve house staff in quality improv ement activities to improve patient care and to enhance the education of house staff regarding quality improvement processes.