Hospitalists play a key role in procedural training at many academic institutions and are frequently called on to assist with vascular access. PICCs have been shown to be safe and cost effective. Their use in hospitalized patients continues to increase, which can overburden interventional radiology (IR) services. Bedside placement with ultrasound can result in significant cost savings compared with IR. Because of these factors and the demand for hospitals to reduce costs and improve patient satisfaction, the hospitalist group was asked to develop a dedicated team for bedside PICC placement.
Reduce cost of PICC placement, decrease length of stay, and train residents in the use of ultrasound for vascular access.
In 2005 there were 488 PICCs requested and placed by IR. IR's inability to keep pace with the increasing demand resulted in increasing the length of stay (LOS). That, combined with the additional cost of the PICC placed in IR, exceeded the fixed payment for hospitalization, resulting in lost revenue for the hospital. A cost analysis showed bedside placement with an 85% success rate could have reduced costs by more than 60% ($365,000). In view of this data, it was decided to start a hospitalist PICC program. A PICC consultant firm in collaboration with IR trained and certified 2 members of the hospitalist group. A portable ultrasound was purchased ($21,000). A curriculum including hands‐on simulation was developed to train and certify the remaining hospitalist and residents. A formal evaluation to determine the appropriateness of a PICC was developed and implemented.
In the first 12 months there were 460 requests (6% decrease). Two hundred and twenty‐three (49%) were deemed inappropriate (64 [14%] had appropriate access, 159 [35%] PICC was not indicated). Of the 237 requests deemed appropriate (51%), 221 were placed at the bedside, with a success rate of 93.25%. Sixteen (6.75%) were sent to IR. The combination of beside placement and decreasing the number of PICCs being placed inappropriately translated to an 84% ($462,000) cost savings compared with all requested PICCs being placed by IR as in previous years. By providing 7‐day‐a‐week availability, there may be additional cost savings by reducing LOS. The hospitalist generated 468 RVUs and $38,277 (at 9 months). The program has provided the residents with a controlled nonemergent way to learn ultrasound‐guided vascular access. Resident feedback about the training has been uniformly positive. To date, 7 are certified and now use this skill in the ICU. Patient feedback about having the procedure done at bedside instead of in IR generally has been positive.
J. Jordan, none; J. Halm, none; J. Qureshi, none; M. Ahmed, none; J. Gonzales, none.
To cite this abstract:Jordan J, Halm J, Qureshi J, Ahmed M, Gonzales J. Benefits of Initiating a Hospitalist PICC Program — Experience from an Academic Community Medical Center. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 106. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/benefits-of-initiating-a-hospitalist-picc-program-experience-from-an-academic-community-medical-center/. Accessed July 22, 2019.