Research led by Amsterdam UMC, over 5 years and 1100 patients, has shown a strategy to reduce inappropriate IV use by a third, an effect that was maintained throughout the five years. This should also lead to a reduction in associated infections which affect one in ten patients. These results are published today at The Lancet eClinical Medicine.
“Infections caused by both IVs and catheters occur in more than 10% of patients, and studies show that up to a quarter are unnecessary. It simply means that patients are at an unreasonably high risk of infection. This can to delay or even prevent their recovery,” says Suzanne Geerlings, professor of internal medicine at UMC Amsterdam.
To combat this, the research team published a strategy in Lancet Infectious Diseases in 2017. This strategy resulted in a 37% reduction in the number of unnecessary or inappropriately used catheters.
“When we talk about inappropriate use, this usually refers to catheters that are in place for too long or, in the case of urinary catheters, when there is insufficient support for the patient,” adds Geerlings.
Of the 1,113 patients included in the study, 962 received an IV catheter, commonly used to administer fluids, with the remaining 151 receiving a urinary catheter and the remaining 962 receiving an IV catheter.
“What’s really interesting is that no study has ever looked at how long-lasting these recommendations are, and that’s true of many new strategies in health care. In this case, we clearly see that the results have been sustained over the last five years.” says Geerlings.
The what, now the why
To understand why their strategy continued to work, the research team conducted interviews with 18 healthcare professionals across the Netherlands. These interviews revealed that the strategy had permanently changed the workflow in four of the five hospitals included in the study.
“By talking to those on the ground, we learned what worked and, perhaps more importantly, what didn’t,” says Tessa van Horrik, researcher at Amsterdam UMC and first author of the study.
“The key barriers to sustaining the strategy were a combination of other priorities, lack of time, staff or both and, understandably, in some cases, there was simply no one to guide implementation over the five-year period. it shows us that the strategy can work, as long as the resources are there.” adds van Horrik.
Although, the study also showed that these resources need not be permanent. A temporary investment, either in time or leadership, was shown to be sufficient to reduce unnecessary or inappropriate IV and catheter use.
