Improving PICC use and outcomes in hospitalised patients: an interrupted time series study using MAGIC criteria
BACKGROUND: Although important in clinical care, reports of inappropriate peripherally inserted central catheter (PICC) use are growing.
OBJECTIVE: To test whether implementation of the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) can improve PICC use and patient outcomes.
DESIGN: Quasi-experimental, interrupted time series design at one study site with nine contemporaneous external controls.
SETTING: Ten hospitals participating in a state-wide quality collaborative from 1 August 2014 to 31 July 2016.
PATIENTS: 963 hospitalised patients who received a PICC at the study site vs 6613 patients at nine control sites.
INTERVENTION: A multimodal intervention (tool, training, electronic changes, education) derived from MAGIC.
MEASUREMENTS: Appropriateness of PICC use and rates of PICC-associated complications. Segmented Poisson regression was used for analyses.
RESULTS: Absolute rates of inappropriate PICC use decreased substantially at the study site versus controls (91.3% to 65.3% (-26.0%) vs 72.2% to 69.6% (-2.6%); P<0.001). After adjusting for underlying trends and patient characteristics, however, a marginally significant 13.8% decrease in inappropriate PICC use occurred at the study site (incidence rate ratio 0.86 (95% CI 0.74 to 0.99; P=0.048)); no change was observed at control sites. While the incidence of all PICC complications decreased to a greater extent at the study site, the absolute difference between controls and intervention was small (33.9% to 26.7% (-7.2%) vs 22.4% to 20.8% (-1.6%); P=0.036).
LIMITATIONS: Non-randomised design limits inference; the most effective component of the multimodal intervention is unknown; effects following implementation were modest.
CONCLUSIONS: In a multihospital quality improvement project, implementation of MAGIC improved PICC appropriateness and reduced complications to a modest extent. Given the size and resources required for this study, future work should consider cost-to-benefit ratio of similar approaches.
Swaminathan, L., Flanders, S., Rogers, M., Calleja, Y., Snyder, A., Thyagarajan, R., . . . Chopra, V. (2018). Improving PICC use and outcomes in hospitalised patients: an interrupted time series study using MAGIC criteria. BMJ Qual Saf, 27(4), 271-278. doi: 10.1136/bmjqs-2017-007342