Richard Fabian

Establishing an ultrasound-guided vascular access program: A powerful tool for patient care

March 22, 2022
by Gus Iversen, Editor in Chief
Healthcare Business News spoke once again with Fujifilm SonoSite president and COO Richard Fabian about what is clearly a passion of his: ensuring that peripheral IVs are inserted correctly on the first try using point-of-care ultrasound guidance.

He explains that it is a simple but powerful way to improve nurse satisfaction, patient care, comfort and perception—and the resulting savings can be significant.

HCB News: Why is an ultrasound-guided peripheral IV program so important for a hospital? And how does it differ from the traditional approach to IV insertion?
Richard Fabian: For hospitals, these programs mean major, measurable improvements in patient safety and in the quality of care. They may also mean savings in the realm of millions per year from more efficient patient throughput, better use of staff time, reducing more expensive and risky procedures and avoidable complications, and improving time to treatment—something especially important particularly in the ED. The source of these benefits is simple: empowering front-line clinicians to use ultrasound to guide the placement of peripheral IV lines.

HCB News: How would a hospital measure these benefits?
RF: Let’s start with the scope, which is massive. The number of peripheral IVs placed in the US every year is somewhere between 200 and 300 million. Within this number, there are millions of patients whose veins are so difficult to access—whether because of anatomy, or because they have an illness or another complicating factor—that they get escalated from nurse to nurse and physician to physician before the PICC (peripherally inserted central catheter) team gets involved. These patients may even undergo a central venous catheter (CVC) procedure, which is much riskier and far more costly than a peripheral IV. At St. Joseph’s Healthcare System in New Jersey, their vascular access program saved a total of $3.5 million in three years, in part by reducing referrals out for PICCs and CVCs.

The benefits will be slightly different depending on the hospital department in question, but for emergent care, the time-to-treatment is certainly one of the most consequential. A PICC takes upwards of 45 minutes to place, while an ultrasound-guided PIV takes between 5 and 10 minutes. Many time-sensitive lifesaving therapies cannot be administered without an IV placed, nor can emergency patients be transferred to surgery or critical care unit. For the vast majority of all patients, not just in the ED, that IV placement is the first point of contact with their care team, and it affects their experience and how they perceive the hospital and their care.

HCB News: Great, I was going to ask about the patient experience. What does an ultrasound-guided peripheral IV program do for patients in that regard?
RF: This is something most of us have some experience with. If an IV placement goes well, no big deal. But if it’s not inserted correctly on the first try, there can be pain, bruising, and an increased risk of bloodstream infection. There also may be a sharp loss of confidence in the practitioner. It can honestly be traumatic for the patient and the family. That’s particularly true when the patient is a child; children’s veins are notoriously difficult to access.

A positive way to phrase this is that a vascular access program means that IVs are placed quickly and correctly—and that single interaction demonstrably improves patient experience. In a study published in the Annals of Emergency Medicine, for instance, two university hospital emergency departments found that ultrasound-guided peripheral IV programs increased their patient satisfaction scores by 3 points on a 10-point scale versus the traditional landmark approach. Not only are those scores likely to affect whether or not a patient maintains a relationship with their physician, they are likely to have a ripple effect throughout the hospital. Studies, including one published in the Journal of Family Practice found that patients keep or change providers based upon experiences. Relationship quality is a major predictor of patient loyalty. Another study found patients reporting the poorest-quality relationships with their physicians were three times more likely to voluntarily leave the physician's practice than patients with the highest-quality relationships. Moreover, any improvement in patient satisfaction scores is likely to have a ripple effect throughout the hospital.

HCB News: So what you’re talking about is mainly patient perception or family satisfaction.
RF: Yes, those are absolutely paramount. But there’s another aspect here, too: the toll a difficult IV placement takes on the nurse making the attempt. The nurses I know are extremely dedicated and compassionate professionals. It is beyond frustrating for them to have to stick a patient two or three times when, with better tools or training, they could do it on the first try with every patient. I believe that staff satisfaction is an underrecognized benefit of these vascular access programs. We all know how a few extra points on the patient satisfaction scores contribute to the hospital’s bottom line, but staff morale and confidence isn’t measured quite as often. The staff will also appreciate the investment in their personal development as well as a tangible capital asset in the form of their dedicated ultrasound device.

HCB News: Are these types of programs common in U.S. hospitals?
RF: In terms of program adoption across the board, my sense is that many of the country’s leading institutions have an ultrasound-guided vascular access program in place, but ultrasound-guided peripheral IV placement remains an area of opportunity for most hospitals or clinics. I know eminent institutions like Cedars-Sinai and Northwestern have embraced them enthusiastically, but different institutions come to it in different ways. First off, these are typically nurse-led initiatives. At some mid-sized institutions, it may start off with training one or two vascular access experts in the use of ultrasound to place peripheral IVs for chemotherapy patients, patients who have used IV drugs, or patients whose anatomy make the placement challenging. In at least a few hospitals I know about, the surging demand for that expertise prompted them to train more nurses in the process. Bigger hospitals and health systems may enlist industry partners like us who can help with technology, training, and customer best practices to create a system-wide plan for adoption; such partnerships often come with a set training plan and support with program operation, guidelines, and measurement.

HCB News: How would you advise people to advocate for a program like this at their hospital?
RF: That advocacy may take a different form depending on the size and orientation of the hospital. But a program like this should be a no-brainer. It just checks all the boxes: it’s a commonsense way to reduce pain and fear for patients, it empowers staff and enables them to use their time more efficiently, and it saves the hospital money. It’s very rewarding to see a program that is great for patients and improves bottom line results.