MP35: An educational and audit-and-feedback approach to decreasing unnecessary intravenous therapy in low-acuity emergency patients

Abstract

Introduction: Intravenous (IV) therapy in the emergency department (ED) is associated with risk of harm from IV complications, higher ED monitoring requirements and increased ED length of stay (LOS), the latter a measure most cumbersome in lower-acuity patients that are eventually discharged from the ED. The aim of this quality improvement project was to evaluate the effectiveness of educational and audit-and-feedback interventions, with a goal of relative reduction of ED IV therapy by 20% over eight week periods, in lower-acuity patients in the high-turnover intake area of the ED who were discharged from the ED. Methods: The first cycle of the project was education about IV therapy use and alternatives in lower-acuity, ED patients (Canadian Triage Acuity Scale (CTAS) 3 and 4) from July 2 to August 31, 2017. Education was delivered through email information, posters, education sessions with nurse educators, and working groups sharing information. The second cycle of the project, from October 16 to December 15, 2017, also integrated an audit-and-feedback tool whereby physicians received their own pooled ordering data of IVs from the same period the previous year and then trial period as well pooled comparison averages for the physician group in the population of interest. Measures were the percentage of IVs ordered by physicians and administered by nurses in the population of interest in each time period. Results: From July 2 to August 31, 2017, when the intervention was education only, the rate of IV therapy changed from 31% to 37%, which reflects a 19% relative increase in IV use. In the beginning of the second cycle utilizing both education and audit-and-feedback interventions, from October 16 to December 15, 2017, 35% of patients had IV therapy. At the end of the second cycle, 25% of patients had IV therapy, a 28% relative decrease in IV therapy rates. When both cycles are reviewed sequentially, IV therapy rates decreased from 31% to 25%, a relative reduction of IV usage of 19%. Conclusion: In this quality improvement project, an educational initiative for the interdisciplinary team alone did not reduce IV use in lower-acuity patients. Concurrent education and audit-and-feedback interventions were more effective than education alone in decreasing IV therapy in appropriately selected patients in a tertiary ED.