The culture of healthcare is changing. We are going from a system of quality at all costs to one of quality at the best cost. Many Maryland hospitals are now operating as so-called Total Patient Revenue (TPR) health systems, giving real financial incentives to hospitals that reduce the cost of care.
One new initiative our group is implementing to help hospitals both reduce costs and improve quality of care is standardized and broad use of bedside ultrasound, in particular for peripheral IV placement.
When someone comes to the Emergency Department with chest pain, one of the first things they receive is a peripheral IV. For certain patients, placing an IV in their arm can be so difficult that a physician is called on to place a central line, otherwise known as a central venous catheter, which goes from the patient’s neck directly to their heart.
It is a procedure fraught with risks. Complications include collapsed lungs, infections, bleeding, and even death. Central line placement has very specific indications and should not be done cavalierly. Not only are they dangerous, but they are costly. The equipment alone costs twenty times that needed for a peripheral IV.
We are now working to ensure that providers have an alternative to central line placement: ultrasound guidance to place a peripheral IV. The use of ultrasound improves both the quality of that patient’s care, while drastically reducing the cost, and above all, the risks of an unnecessary and dangerous procedure.
In July 2012, an article in the American Journal of Emergency Medicine looked at the effect of ultrasound guided peripheral IV placement on the number of central venous catheters placed in patients with difficult IV access. The paper suggested that using ultrasound guidance decreased the placement of a central line by as much as 85% in a busy emergency department.
Based on that article and several similar conclusions following it, MEP has embarked upon an initiative to educate and train all of its APPs (Advanced Practice Professionals) on placing peripheral IVs using ultrasound guidance. Through a series of workshops, we have gradually given providers at most of our campuses the skills needed to place ultrasound guided peripheral IVs. We also offer that same training to all other levels of staff at each of its hospital partners.
This past Monday, at the St. Mary’s Hospital campus in Leonardtown, Maryland, the ultrasound team conducted a workshop that was attended by not only physicians and APPs, but also nurses and patient care technicians. During the course of a three hour workshop, more than a dozen people from all levels of patient care were trained in a procedure proven to reduce central lines.
The program fosters both education and teamwork – teaching everyone a potentially life saving skill. We seek to go beyond reduce cost, we constantly seek to improve the quality of the care we provide.