CE Article: Use of an Evidence-Based Protocol for Repositioning Peripherally Inserted Central Catheters (PICCs) in Children and AdultsCE

2021 ◽  
Vol 26 (1) ◽  
pp. 6-14
Author(s):  
Jorge Mesa ◽  
Amalyn Mejia ◽  
Gareth Tiu
Keyword(s):  
Cost Savings ◽  
Intrathoracic Pressure ◽  
Evidence Based ◽  
Catheter Position ◽  
Standardized Protocol ◽  
Catheter Exchange ◽  
Unnecessary Procedures ◽  
Pediatric Populations ◽  
Tip Position ◽  
Central Catheters

Highlights Abstract Introduction: Achieving and maintaining optimal peripherally inserted central catheter (PICC) tip position can be challenging. At any time during therapies, the final catheter position can be altered due to changes in patient condition and intrathoracic pressure. Aim: To determine if the use of a standardized protocol with power flush option for repositioning the PICC tips will reduce the number of withdrawal interventions or exchange procedures. Methods: Johns Hopkins evidence-based practice (EBP) methodology was used to evaluate literature published in the past 5 years. A standardized protocol was developed and implemented in patients with malpositioned PICCs. The outcome measures were the successful repositioning of the catheter and costs for the procedure. Results: In 4 months, 43 (93%) of 46 (14 adult/32 pediatric) catheters were successfully repositioned. The withdrawal method was used to reposition 34 (73.9%). In 12 patients where a power flush was used, 9 (75%) were successfully repositioned. These changes resulted in decreased delays in treatment and financial savings of $235,210 in personnel time and supplies. Discussion: The standardized protocol provided an alternative to previous practices, extending dwell time, decreasing treatment delay, and unnecessary procedures, showing significant savings for the institution. Conclusions: The Vascular Access Team use of an evidence-based protocol was successful in reducing catheter exchange and withdrawals in malpositioned catheters among adult and pediatric populations. Relevance to Clinical Practice: The implementation of a standardized EBP to address malpositioned catheters resulted in the decreased need for catheter exchange, reduced delays in treatment, and cost savings.

scholarly journals The SIF protocol: A seven-step strategy to minimize complications potentially related to the insertion of femorally inserted central catheters

2021 ◽  
pp. 112972982110414
Author(s):  
Fabrizio Brescia ◽  
Mauro Pittiruti ◽  
Matthew Ostroff ◽  
Timothy R Spencer ◽  
Robert B Dawson
Keyword(s):  
Central Venous Access ◽  
Venous Access ◽  
Late Complications ◽  
Exit Site ◽  
Central Venous ◽  
Standardized Protocol ◽  
Tip Position ◽  
Correct Application ◽  
Ultrasound Guided Puncture ◽  
Central Catheters

The insertion of central venous catheters through the femoral veins is not uncommon and is potentially associated with the risk of immediate puncture-related complications and severe late complications as infection and thrombosis. As for other central venous access devices, the use of a standardized protocol of insertion and the correct application of evidence-based strategies are beneficial in reducing the risk of complications. We proposed a standardized protocol (S.I.F.: Safe Insertion of Femorally Inserted Central Catheters) consisting of seven strategies that should be part of vascular cannulation and should be adopted during the insertion of femoral venous catheters, aiming to minimize immediate, early and late insertion-related complications. These strategies include: preprocedural evaluation of the patient history and of the veins, appropriate aseptic technique, ultrasound guided puncture and cannulation of the vein, intra-procedural assessment of the tip position, adequate protection of the exit site, proper securement of the catheter, and appropriate coverage of the exit site.

scholarly journals The SIC protocol: A seven-step strategy to minimize complications potentially related to the insertion of centrally inserted central catheters

2021 ◽  
pp. 112972982110360
Author(s):  
Fabrizio Brescia ◽  
Mauro Pittiruti ◽  
Matthew Ostroff ◽  
Timothy R Spencer ◽  
Robert B Dawson
Keyword(s):  
Central Venous Catheters ◽  
Immediate Early ◽  
Thoracic Region ◽  
Exit Site ◽  
Central Venous ◽  
Standardized Protocol ◽  
Adequate Coverage ◽  
Tip Position ◽  
Central Catheters ◽  
Late Insertion

Insertion of central venous catheters in the cervico-thoracic area is potentially associated with the risk of immediate/early untoward events, some of them negligible (repeated punctures), some relevant (accidental arterial puncture), and some severe (pneumothorax). Furthermore, different strategies adopted during insertion may reduce or increase the incidence of late catheter-related complications (infection, venous thrombosis, dislodgment). This paper describes a standardized protocol (S.I.C.: Safe Insertion of Centrally Inserted Central Catheters) for the systematic application of seven basic beneficial strategies to be adopted during insertion of central venous catheters in the cervico-thoracic region, aiming to minimize immediate, early, or late insertion-related complications. These strategies include: preprocedural evaluation, appropriate aseptic technique, ultrasound guided insertion, intra-procedural assessment of the tip position, adequate protection of the exit site, proper securement of the catheter, and adequate coverage of the exit site.

Aligning the flow cytometric evaluation with the diagnostic need: an evidence-based approach

2017 ◽  
Vol 70 (9) ◽  
pp. 740-744 ◽  
Author(s):  
Dawn Williams-Voorbeijtel ◽  
Francisco Sanchez ◽  
Christine G Roth
Keyword(s):  
Clinical Care ◽  
Cost Savings ◽  
Value Added ◽  
Cost Effective ◽  
Just In Time ◽  
Evidence Based ◽  
Flow Cytometric ◽  
A Value ◽  
Screening Approach ◽  
Minimum Requirements

AimsElimination of non-value added testing without compromising high-quality clinical care is an important mandate for laboratories in a value-based reimbursement system. The goal of this study was to determine the optimal combination of flow cytometric markers for a screening approach that balances efficiency and accuracy.MethodsAn audit over 9 months of flow cytometric testing was performed, including rereview of all dot plots from positive cases.ResultsOf the 807 cases in which leukaemia/lymphoma testing was performed, 23 were non-diagnostic and 189 represented bronchoalveolar lavage specimens. Of the remaining 595 cases, 137 (23%) were positive for an abnormal haematolymphoid population. Review of the positive cases identified minimum requirements for a screening tube as well as analysis strategies to overcome the diagnostic pitfalls noted. It is estimated that 38% fewer antibodies would be used in a screening approach, representing an opportunity for significant cost savings.ConclusionsWe provide a framework for developing an evidence-based screening combination for cost-effective characterisation of haematolymphoid malignancies, promoting adoption of ‘just-in-time’ testing systems that tailor the evaluation to the diagnostic need.

Implementation of Evidence-Based Presurgical Testing Guidelines in Patients Undergoing Ambulatory Surgery for Endometrial Cancer

2021 ◽  
pp. OP.21.00247
Author(s):  
Emeline M. Aviki ◽  
Sushmita B. Gordhandas ◽  
Jeena Velzen ◽  
Michael Riley ◽  
Beryl Manning-Geist ◽  
...  
Keyword(s):  
Adverse Events ◽  
Ambulatory Surgery ◽  
Cost Savings ◽  
Ambulatory Setting ◽  
Comprehensive Cancer Center ◽  
Gynecologic Surgery ◽  
Evidence Based ◽  
X Rays ◽  
Time Periods ◽  
Endometrial Pathology

PURPOSE: The aim of this quality improvement intervention was to evaluate the safety and cost savings of presurgical testing (PST) guidelines for patients undergoing hysterectomy for endometrial pathology in the ambulatory setting. METHODS: Evidence-based presurgical testing (PST) guidelines were developed by a multidisciplinary team. These guidelines were implemented on the gynecologic surgery service of a comprehensive cancer center in January 2016. All patients with a diagnosis of endometrial pathology who underwent ambulatory surgery during the specified time periods were included in this analysis. A pre-post analysis was performed (preperiod, July 2014-December 2015; postperiod, July 2016-December 2017). Rates of completed presurgical tests and perioperative adverse events were compared between time periods. Cost savings related to the reduction in PST were calculated using the direct cost of testing and reported in percentage cost reduction. RESULTS: A total of 749 hysterectomies were completed in the preperiod and 775 in the postperiod. After implementation of PST guidelines, complete blood counts, coagulation testing, comprehensive metabolic panels, chest x-rays, and electrocardiograms were reduced by 13.4%, 78.1%, 36.8%, 39.0%, and 15.5%, respectively (all P < .001). Rates of perioperative cardiopulmonary adverse events (0% v 0%) and hematologic adverse events (3.3% v 2.0%; P = .10) were stable between time periods. There were no deaths within 90 days of surgery. There was a 41.4% reduction in direct costs related to PST in the postperiod. CONCLUSION: The use of evidence-based PST guidelines for patients with endometrial pathology undergoing hysterectomy in the ambulatory setting is safe and cost-effective. A multidisciplinary approach is essential for successful development and implementation.

Evaluation, Development, and Implementation of Potentially Better Practices in Neonatal Intensive Care Nutrition

PEDIATRICS ◽  
2003 ◽  
Vol 111 (Supplement_E1) ◽  
pp. e461-e470
Author(s):  
Barbara Kuzma-O’Reilly ◽  
Maria L. Duenas ◽  
Coleen Greecher ◽  
Lois Kimberlin ◽  
Dennis Mujsce ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Neonatal Intensive Care ◽  
Outcome Measure ◽  
Implementation Strategies ◽  
Cost Savings ◽  
Nutrition Support ◽  
Evidence Based ◽  
Published Evidence ◽  
Support Practices ◽  
Neonatal Population

Objective. The desire for evidence-based clinical guidelines for nutritional support of the preterm infant has been identified. Published evidence has not yielded clear guidelines about the best method of delivery, substrate use, or appropriate outcome measure to evaluate nutrition support. In addition, reports on research of nutrition support often fail to give the most rudimentary process necessary to improve quality in various unit settings. Methods. The Vermont Oxford Network “Got Milk” focus group developed eight potentially better practices for nutrition support, implementation strategies for these practices, and a comprehensive appraisal process to measure nutrition outcome in preterm infants. Results. After implementation of the potentially better practices, all participating institutions showed earlier initiation of nutrition support, earlier attainment of adequate energy intakes, reduced delay in reaching full enteral feeds, more consistent nutrition support practice, decreased length of stay, cost savings, and improved growth at time of discharge. Conclusions. Development and implementation of evidence-based better nutrition support practices in neonates led to improved nutrient intake and growth with reduced length of stay and related costs. Consistent, comprehensive, multidisciplinary appraisal of practice is an integral component of improving nutrition outcomes in the neonatal population.

States' Budget Investments in Technology and Improving Criminal Justice Outcomes

2018 ◽  
pp. 90-105
Author(s):  
Deborah Mohammed-Spigner ◽  
Brian E. Porter ◽  
Lois M. Warner
Keyword(s):  
Information Technology ◽  
Criminal Justice ◽  
Public Safety ◽  
Prison Population ◽  
Cost Savings ◽  
Rate Of Return ◽  
Drug Courts ◽  
Evidence Based ◽  
Criminal Justice Reform ◽  
Prison Populations

Investments in criminal justice have been expanding over the decades especially as specific outcomes have been sought to address the issues surrounding crime and public safety. Reducing crime and the rate of imprisonment can both significantly impact public safety and cost savings, as well as address outcomes for the justice-involved population in reducing the rate of return to imprisonment, or recidivism. Lessening sentences for non-violent crimes and expanding drug courts as an alternative to incarceration, along with other major criminal justice reform, have led some states to experience a reduction in crime and prison population. New Jersey, Hawaii, and California have made significant strides to reduce its crime and prison populations and are leaders in achieving major criminal justice reform. This chapter seeks to examine corrections spending for these three leading states that have implemented evidence-based policies and adapted information technology to improve criminal justice outcomes. It will also outline states spending on corrections over the past five years.

scholarly journals Appropriate Use Criteria and the Imaging Mandate

2017 ◽  
pp. 1
Author(s):  
Gregory J Dehmer ◽  
Leah White ◽  
John U Doherty ◽  
◽  
◽  
...  
Keyword(s):  
Imaging Modality ◽  
Clinical Care ◽  
Cost Savings ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Testing Procedures ◽  
Multiple Imaging ◽  
Clinical Scenarios ◽  
Unnecessary Procedures

Appropriate use criteria (AUC) have existed for over 30 years and are being deployed with increasing frequency to study the delivery of healthcare. The goal of AUC is to advise all stakeholders about the reasonable use of testing procedures or therapies to improve symptoms, quality of life, and health outcomes. Numerous studies have shown the favorable effects of AUC to limit the overuse of unnecessary procedures while also promoting high-quality clinical care and cost savings. AUC evaluating only a single imaging modality have been replaced by multimodality documents, making it easier for the clinician to evaluate the appropriateness of multiple imaging methods in various clinical scenarios. The Protecting Access to Medicare Act of 2014 contained language mandating the use of AUC when ordering certain advanced cardiac imaging tests, and this requirement is currently scheduled for implementation in January 2020. Clinicians need to be aware of the increasing use of AUC and the financial implications of the AUC mandate legislation.

scholarly journals Availability and accessibility of evidence-based information resources provided by medical libraries in Australia

2000 ◽  
Vol 23 (1) ◽  
pp. 77 ◽  
Author(s):  
Ann Ritchie ◽  
Beth Sowter
Keyword(s):  
Cost Savings ◽  
Information Resources ◽  
Cochrane Library ◽  
Evidence Based ◽  
Clinical Workflow ◽  
Public And Private ◽  
Medical Libraries ◽  
On Line ◽  
Internal Networks ◽  
Line Technology

This article reports on the results of an exploratory survey of the availability andaccessibility of evidence-based information resources provided by medical libraries inAustralia. Although barriers impede access to evidence-based information for hospitalclinicians, the survey revealed that Medline and Cinahl are available in over 90% offacilities. In most cases they are widely accessible via internal networks and the Internet.The Cochrane Library is available in 69% of cases. The Internet is widely accessible andmost libraries provide access to some full-text, electronic journals. Strategies for overcomingrestrictions and integrating information resources with clinical workflow are being pursued.State, regional and national public and private consortia are developing agreementsutilising on-line technology. These could produce cost savings and more equitable accessto a greater range of evidence-based resources.

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