30% of emergency patient cannulas unnecessary

Research in a major Australian hospital has found that 30% of cannulas given to emergency department patients are not required, and that reducing the number of needles used in emergency could ultimately save the nation’s healthcare system more than $13 million every year.

The research was undertaken at Royal Brisbane and Women’s Hospital (RBWH) Emergency and Trauma Centre where, following a three-month trial, the number of cannulas inserted was reduced to three in 10 emergency patients. In response the hospital has developed an educational program known as CREDIT, which is being taken up by other hospitals nationally.

“In almost all emergency patients cannulas are put in too soon. They’re great to easily give patients fluids and medications or have blood taken, but they aren’t always needed,” said RBWH Emergency and Trauma Centre Senior Staff Specialist Professor Louise Cullen.

“We’re needlessly spending 15 minutes of staff time to put patients through an unnecessary and painful procedure that’s increasing their risk of contracting a blood infection.”¹

RBWH Emergency and Trauma Centre Clinical Research Nurse Tracey Hawkins said hospitals needed to change the culture of needles being a routine part of the admission process.

“Now at every clinical handover, we ask staff to be 80% sure they would use a cannula before they insert one,” she said. “Evidence showed us that many of our patients were getting cannulas that were not being used and through our research we realised that there was a culture of the ‘just in case cannula’ involved.

“When you’re in a busy clinical environment and making a lot of decisions you tend to follow a common pattern of behaviour, and we needed to find a way to empower our clinicians to stop and consider the need for the cannula — is it necessary?”

Decision-making tools

A range of tools was implemented to promote clinical decision-making among the staff of the RBWH Emergency and Trauma Centre. “We came at staff with our message from all angles: education and training sessions, visual aids, real-time surveillance and feedback sessions, and change champions who prompted staff throughout their shifts.

“Any behaviour change is hard and even more so in a clinical setting because we have a natural urge to ‘do something’ to help our patients. It has been a great reminder that part of value-based medical care is preventing unnecessary tests and procedures, and that sometimes we need to practice deliberate clinical inertia — the art of doing nothing as a positive response.”

Emergency Medicine Foundation (EMF) Chair Dr Anthony Bell said hospital emergency departments around the country had expressed interest in the program, with several hospitals in Queensland commencing implementation this month (February).

“This research is an example of emergency clinicians seeing an issue and developing a solution,” said Dr Bell.

EMF awarded the team an $80,000 research grant to trial the program, with funding from Queensland Health, and the Metro North Hospital and Health Service contributing a further $20,000. In an economic analysis, the RBWH team found the average cost of inserting each cannula at the hospital was $22.80 and that if the CREDIT program was rolled out nationally, it could potentially save more than $13.7 million each year.

The RBWH research team collaborated with the Griffith University Health Economics Unit and the Alliance for Vascular Access Teaching and Research (AVATAR) as well as Monash Medical Centre’s Associate Professor Diana Egerton-Warburton.

To find out more about the CREDIT study, see the January edition of Academic Emergency Medicine or listen to Ms Hawkins’ interview on the Skeptics Guide to Emergency Medicine podcast.

1. In Australia, cannulas lead to more than 3500 cases of blood stream infections annually.

Image credit: ©stock.adobe.com/au/Kristin Gründler