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Evaluating the sustained effectiveness of a multimodal intervention aimed at influencing PIVC insertion practices in the emergency department
  1. Zheng Jie Lim1,
  2. Daniel Nagle2,
  3. Fern McAllan3,
  4. Radha Ramanan4,
  5. Claire Dendle5,
  6. Rhonda L Stuart5,6,
  7. Diana Egerton-Warburton5,7
  1. 1 Department of Intensive Care and Anaesthesia, Ballarat Health Services, Ballarat, Victoria, Australia
  2. 2 Barwon Health, Geelong, Victoria, Australia
  3. 3 Emergency Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  4. 4 Department of Haematology, Austin Health, Heidelberg, Victoria, Australia
  5. 5 School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
  6. 6 Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia
  7. 7 Emergency Department, Monash Health, Clayton, Victoria, Australia
  1. Correspondence to Dr Zheng Jie Lim, Department of Intensive Care and Anaesthesia, Ballarat Health Services, Ballarat, VIC 3350, Australia; zhengjie.lim{at}


Introduction Multimodal interventions (MMI) are frequently used in various healthcare settings to encourage change in healthcare personnel practices and improve patient safety. In 2013, an MMI conducted in an Australian metropolitan ED used clinician champions, guidelines, education sessions and promotional materials to encourage a reduction in unused and inappropriate peripheral intravenous cannulas (PIVC). A 60-day postintervention demonstrated a successful reduction in the number of unused PIVCs without changes in appropriate insertions. We aimed to investigate if this MMI produced a sustained effect in reducing the frequency of unused PIVCs inserted in this ED.

Methods A single-centre retrospective cohort study of adult patients presenting to the above ED in Victoria, Australia, was conducted in April 2018. A random sample of 380 patients with a PIVC inserted in ED was assessed to determine if the PIVC was used (termed ‘Long-term follow-up’). The appropriateness of unused PIVCs was assessed. Our findings were compared with previously collected data in 2013 (‘Pre-Intervention’ and ‘Immediately Post-Intervention’) to determine a sustained reduction in the frequency of unused PIVC insertions was achieved. Long-term analysis of the MMI, including the overall frequency of PIVC insertions in ED before and after the MMI, was also collected.

Results In our Long-term follow-up cohort, 101 of 373 (27.1%, 95% CI 22.6% to 31.9%) PIVCs were unused (seven cases excluded). This was significantly lower than the Pre-Intervention cohort (139/376, 37.0%, 95% CI 32.1% to 42.1%). While not significant, the frequency of unused PIVCs in the Post-Intervention cohort was lower in comparison (73/378, 19.3%, 95% CI 15.4% to 23.7%). No significant change in the appropriateness of unused PIVCs was observed between the Post-Intervention and Long-term follow-up. The overall proportion of patients receiving a PIVC has remained low since the MMI.

Conclusion An MMI aimed at reducing unused PIVC insertions in ED has been effective in eliciting sustained change. Unused but appropriately inserted PIVCs seem unaffected by the intervention.

  • emergency department
  • education
  • quality improvement

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  • Contributors ZJL and DN were responsible for the statistical analysis, data interpretation and presentation of data and figures. ZJL, DN and DEW were responsible for the literature review and writing of the article. FM, CD, RR and RS were responsible for the original idea of the multimodal intervention. DEW was responsible for reviewing the article and supervising the project. DEW takes responsibility for the paper as a whole.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval was obtained from the Monash Health Ethics Committee (Clayton, Victoria, Australia) (ethics approval number RES-18-0000-314Q).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Information has been saved as deidentified participant data.