Difficult intravenous access as an independent predictor of delayed care and prolonged length of stay in the emergency department.

Content Provider	Europe PMC
Author	Shokoohi, Hamid Loesche, Michael A. Duggan, Nicole M. Liteplo, Andrew S. Huang, Calvin Al Saud, Ahad A. McEvoy, Dustin Liu, Shan W. Dutta, Sayon
Abstract	ObjectivesDifficult intravenous access (DIVA) is common in the emergency department (ED). We investigated the extent to which DIVA is associated with care delay outcomes including time to first laboratory draw, therapies, imaging, and ED disposition.MethodsAn observational retrospective cohort analysis of patients with DIVA treated between 2018 and 2020 at 2 urban academic EDs was performed. DIVA was defined as patients requiring ultrasound‐guided intravenous access placed by physicians or advanced practice providers (APPs) as opposed to landmark‐based intravenous placement by nurses. ED throughput variables and disposition time were compared. We correlated DIVA with time to administration of intravenous pain medications, fluids, imaging contrast, laboratory results, and ED disposition.ResultsA total of 108,256 subjects with 161,122 total encounters were included. DIVA occurred in 4961 (3.1%) of ED visits. Patients with DIVA were more likely to be female (3.5% vs 2.6% for males, odds ratio [OR] 1.34, 95% confidence interval [CI]: 1.27–1.42), self‐identify as black (OR 1.78, 95% CI: 1.66–1.91), and have higher acuity of illness (P < 0.001). Among pediatric patients, DIVA occurred most often in the first year of life at a rate of 3.25%. In adults, DIVA occurred in 2 age peaks; at 35 years (4.02%), and at 63 years (3.44%). In all workflow metrics, the presence of DIVA was associated with significant delays in median time to completion: 50 minutes for pain medication administration, 36 minutes for intravenous fluid administration, 29 minutes for laboratory results, 57 minutes for intravenous contrast administration, and 87 minutes for discharge orders.ConclusionDIVA was associated with increased time to therapies, diagnostic studies, imaging completion, and ED disposition. A more expeditious approach to achieving intravenous access in patients with predicted DIVA could improve ED throughput and patient care overall.
Page Count	9
Journal	Journal of the American College of Emergency Physicians Open
Volume Number	1
PubMed Central reference number	PMC7771794
Issue Number	6
PubMed reference number	33392574
e-ISSN	26881152
DOI	10.1002/emp2.12222
Language	English
Publisher	John Wiley and Sons Inc.
Publisher Date	2020-08-19
Publisher Place	Hoboken
Access Restriction	Open
Rights License	This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. © 2020 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of the American College of Emergency Physicians.
Subject Keyword	care delay emergency department intravenous access length of stay point‐of‐care ultrasound ultrasound ultrasound‐guided
Content Type	Text
Resource Type	Article
Subject	Emergency Medicine