Abstract:

Background: Central line-associated bloodstream infections (CLABSI) carry serious risks for patients and financial consequences for hospitals. Avoiding unnecessary temporary central venous catheters (CVC) can reduce CLABSI. Critical Care Medicine (CCM) is often consulted to insert CVC when alternatives are unavailable. We aim to describe clinical and financial implications of a CCM-driven vascular access model.

Methods: In this retrospective, observational cohort study, all CLABSI and a sample of CCM consults for CVC insertion on adult medical-surgical inpatient units were reviewed in 2019. Assessment of CVC appropriateness and financial analysis of labor, reimbursement, and attributable CLABSI cost was conducted.

Results: Of 554 CCM consult requests, 75 (13.5%) were for CVC and 36 (48.0%) resulted in CVC insertion; 6 (16.7%) CVC were avoidable. Three CLABSI occurred in avoidable CVC with estimated annual attributable cost of $165,099. Estimated annual CCM consultant cost for CVC was $78,094 generating $110,733 in reimbursement. Overall estimated annual loss was $132,460.

Discussion: Reliance on CCM for intravenous access resulted in avoidable CVC, CLABSI, inefficient physician effort, and financial losses; nurse-driven vascular access models offer potential cost savings and risk reduction.

Conclusion: CCM-driven vascular access models may not be cost-effective; alternatives should be considered for utilization reduction, CLABSI prevention, and financial viability.

Reference:

Tirumandas M, Gendlina I, Figueredo J, Shiloh A, Trachuk P, Jain R, Corpuz M, Spund B, Maity A, Shmunko D, Garcia M, Barthelemy D, Weston G, Madaline T. Analysis of Catheter Utilization, Central Line Associated Bloodstream Infections, and Costs Associated with an Inpatient Critical Care-driven Vascular Access Model. Am J Infect Control. 2020 Oct 17:S0196-6553(20)30924-X. doi: 10.1016/j.ajic.2020.10.006. Epub ahead of print. PMID: 33080360.