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Introduction Multimodal interventions (MMI) are frequently used in various healthcare settings to encourage change in healthcare personnel practices and improve patient safety. In 2013, an MMI conducted in an Australian metropolitan ED used clinician champions, guidelines, education sessions and promotional materials to encourage a reduction in unused and inappropriate peripheral intravenous cannulas (PIVC). A 60-day postintervention demonstrated a successful reduction in the number of unused PIVCs without changes in appropriate insertions. We aimed to investigate if this MMI produced a sustained effect in reducing the frequency of unused PIVCs inserted in this ED. Methods A single-centre retrospective cohort study of adult patients presenting to the above ED in Victoria, Australia, was conducted in April 2018. A random sample of 380 patients with a PIVC inserted in ED was assessed to determine if the PIVC was used (termed Long-term follow-up'). The appropriateness of unused PIVCs was assessed. Our findings were compared with previously collected data in 2013 ( Pre-Intervention' and Immediately Post-Intervention') to determine a sustained reduction in the frequency of unused PIVC insertions was achieved. Long-term analysis of the MMI, including the overall frequency of PIVC insertions in ED before and after the MMI, was also collected. Results In our Long-term follow-up cohort, 101 of 373 (27.1%, 95% CI 22.6% to 31.9%) PIVCs were unused (seven cases excluded). This was significantly lower than the Pre-Intervention cohort (139/376, 37.0%, 95% CI 32.1% to 42.1%). While not significant, the frequency of unused PIVCs in the Post-Intervention cohort was lower in comparison (73/378, 19.3%, 95% CI 15.4% to 23.7%). No significant change in the appropriateness of unused PIVCs was observed between the Post-Intervention and Long-term follow-up. The overall proportion of patients receiving a PIVC has remained low since the MMI. Conclusion An MMI aimed at reducing unused PIVC in

Introduction Multimodal interventions (MMI) are frequently used in various healthcare settings to encourage change in healthcare personnel practices and improve patient safety. In 2013, an MMI conducted in an Australian metropolitan ED used clinician champions, guidelines, education sessions and promotional materials to encourage a reduction in unused and inappropriate peripheral intravenous cannulas (PIVC). A 60-day postintervention demonstrated a successful reduction in the number of unused PIVCs without changes in appropriate insertions. We aimed to investigate if this MMI produced a sustained effect in reducing the frequency of unused PIVCs inserted in this ED. Methods A single-centre retrospective cohort study of adult patients presenting to the above ED in Victoria, Australia, was conducted in April 2018. A random sample of 380 patients with a PIVC inserted in ED was assessed to determine if the PIVC was used (termed Long-term follow-up'). The appropriateness of unused PIVCs was assessed. Our findings were compared with previously collected data in 2013 ( Pre-Intervention' and Immediately Post-Intervention') to determine a sustained reduction in the frequency of unused PIVC insertions was achieved. Long-term analysis of the MMI, including the overall frequency of PIVC insertions in ED before and after the MMI, was also collected. Results In our Long-term follow-up cohort, 101 of 373 (27.1%, 95% CI 22.6% to 31.9%) PIVCs were unused (seven cases excluded). This was significantly lower than the Pre-Intervention cohort (139/376, 37.0%, 95% CI 32.1% to 42.1%). While not significant, the frequency of unused PIVCs in the Post-Intervention cohort was lower in comparison (73/378, 19.3%, 95% CI 15.4% to 23.7%). No significant change in the appropriateness of unused PIVCs was observed between the Post-Intervention and Long-term follow-up. The overall proportion of patients receiving a PIVC has remained low since the MMI. Conclusion An MMI aimed at reducing unused PIVC in

Introduction: Human factors engineering multimodal interventions (MMI) are known to be effective in reducing the rate of unused peripheral intravenous cannulas (PIVCs). However, there has been no research on the long-term effects of these interventions. Our primary aim was to examine the long-term effect of multimodal interventions on PIVC use in the emergency department (ED). Method(s): A single-centre retrospective cohort study of adult patients presenting to the ED was conducted in April 2018, approximately 5 years since the original MMI. This data (termed "Delayed Post-MMI") was compared to previously published data before the MMI ("pre-MMI") and 3 months after the MMI ("Immediately Post-MMI"). The incidence and appropriateness (based on its use, or intentions of use) of PIVCs inserted in a random sample of 380 patients was assessed using a structured electronic medical record review. The rate of PIVC insertion since the original MMI was also investigated. Result(s): A PIVC was inserted in 925 out of 4573 adult patients (20.2%) in the ED during our study period and were included in the delayed post-MMI group. Compared to the previous Pre-MMI cohort, an absolute reduction of 13.7% in idle PIVCs were observed with a relative risk (RR) of 0.6. Out of the random sample of 380 patients, 101 PIVCs were unused (101/373, 27.1%). 23 unused PIVCs were appropriately inserted (23/101, 22.8%) and 78 were idle (78/101. 77.2%). Between the Pre-MMI and Delayed Post-MMI sample of 380 patients, a 9.9% overall absolute reduction of PIVC insertion was observed (RR = 0.733). PIVC insertion rates remained low since theMMI. Conclusion(s): A human factor engineering multimodal intervention is shown to sustain a reduction in overall PIVC insertion rates and idle PIVCs in the ED. Unused but appropriately inserted PIVCs remain unaffected by the intervention.

Objective: Our objective was to examine the impact of a human factor-designed multimodal intervention on the proportion of unused peripheral i.v. cannula (PIVC) insertion in our ED. Method(s): A pre- and post-multimodal intervention retrospective cohort study was conducted using a structured electronic medical record review within a single adult tertiary ED in Australia. Pre-intervention data was collected 30 days prior to the multimodal intervention, with 30 day post-intervention data collected 3 months after the intervention commenced. The rates of PIVC inserted, the unused rate and the unused but appropriately inserted cannulas were the main outcome measures. Result(s): Intravenous cannula insertion rates decreased by 12.9% (95% confidence interval [CI] 12.19-13.61) between the pre-intervention (1413/4167 [33.9%]; 95% CI 32.5-35.4) and post-intervention cohort (928/4421 [21.0%]; 95% CI 19.8-22.2). An analysis of 754 cases (376 pre-intervention and 378 post-intervention) showed that 139 of 376 (37.0%; 95% CI 32.1-42.1) i.v. cannulas were unused pre-intervention, while 73 of 378 (19.3%; 95% CI 15.4-23.7) was unused post-intervention; an absolute reduction of 17.7% (95% CI 14.98-20.42). The relative risk of an unused i.v. cannula was 0.52 (95% CI 0.41-0.67). The proportion of unused but appropriately inserted i.v. cannulas remained unchanged in both cohorts, with a relative risk of 0.91 (95% CI 0.58-1.42). Conclusion(s): Our multimodal intervention successfully reduced the number of unused PIVCs inserted in the ED, with a reduction in overall and unused PIVC insertions without any change in appropriate insertions.Copyright © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine

Objective: Our objective was to examine the impact of a human factor-designed multimodal intervention on the proportion of unused peripheral i.v. cannula (PIVC) insertion in our ED. Method(s): A pre- and post-multimodal intervention retrospective cohort study was conducted using a structured electronic medical record review within a single adult tertiary ED in Australia. Pre-intervention data was collected 30 days prior to the multimodal intervention, with 30 day post-intervention data collected 3 months after the intervention commenced. The rates of PIVC inserted, the unused rate and the unused but appropriately inserted cannulas were the main outcome measures. Result(s): Intravenous cannula insertion rates decreased by 12.9% (95% confidence interval [CI] 12.19-13.61) between the pre-intervention (1413/4167 [33.9%]; 95% CI 32.5-35.4) and post-intervention cohort (928/4421 [21.0%]; 95% CI 19.8-22.2). An analysis of 754 cases (376 pre-intervention and 378 post-intervention) showed that 139 of 376 (37.0%; 95% CI 32.1-42.1) i.v. cannulas were unused pre-intervention, while 73 of 378 (19.3%; 95% CI 15.4-23.7) was unused post-intervention; an absolute reduction of 17.7% (95% CI 14.98-20.42). The relative risk of an unused i.v. cannula was 0.52 (95% CI 0.41-0.67). The proportion of unused but appropriately inserted i.v. cannulas remained unchanged in both cohorts, with a relative risk of 0.91 (95% CI 0.58-1.42). Conclusion(s): Our multimodal intervention successfully reduced the number of unused PIVCs inserted in the ED, with a reduction in overall and unused PIVC insertions without any change in appropriate insertions.Copyright © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine

Introduction: Human factors engineering multimodal interventions (MMI) are known to be effective in reducing the rate of unused peripheral intravenous cannulas (PIVCs). However, there has been no research on the long-term effects of these interventions. Our primary aim was to examine the long-term effect of multimodal interventions on PIVC use in the emergency department (ED). Method(s): A single-centre retrospective cohort study of adult patients presenting to the ED was conducted in April 2018, approximately 5 years since the original MMI. This data (termed "Delayed Post-MMI") was compared to previously published data before the MMI ("pre-MMI") and 3 months after the MMI ("Immediately Post-MMI"). The incidence and appropriateness (based on its use, or intentions of use) of PIVCs inserted in a random sample of 380 patients was assessed using a structured electronic medical record review. The rate of PIVC insertion since the original MMI was also investigated. Result(s): A PIVC was inserted in 925 out of 4573 adult patients (20.2%) in the ED during our study period and were included in the delayed post-MMI group. Compared to the previous Pre-MMI cohort, an absolute reduction of 13.7% in idle PIVCs were observed with a relative risk (RR) of 0.6. Out of the random sample of 380 patients, 101 PIVCs were unused (101/373, 27.1%). 23 unused PIVCs were appropriately inserted (23/101, 22.8%) and 78 were idle (78/101. 77.2%). Between the Pre-MMI and Delayed Post-MMI sample of 380 patients, a 9.9% overall absolute reduction of PIVC insertion was observed (RR = 0.733). PIVC insertion rates remained low since theMMI. Conclusion(s): A human factor engineering multimodal intervention is shown to sustain a reduction in overall PIVC insertion rates and idle PIVCs in the ED. Unused but appropriately inserted PIVCs remain unaffected by the intervention.

More than 500,000 joint replacements are performed in the United States each year and this is expected to increase by at least 50% over the next 10 years [1]. Along with this increasing volume of joint replacements, the rate of revisions for failed hip and knee replacements is expected to increase at a similar rate over time. With all ‘failures’ it is important to carefully analyze the cause of failure in a continual effort to improve patient outcomes. The broad purpose of this study was to allow and facilitate ongoing research at UC San Diego into the mechanisms of failure of joint replacements in general.

More than 500,000 joint replacements are performed in the United States each year and this is expected to increase by at least 50% over the next 10 years [1]. Along with this increasing volume of joint replacements, the rate of revisions for failed hip and knee replacements is expected to increase at a similar rate over time. With all ‘failures’ it is important to carefully analyze the cause of failure in a continual effort to improve patient outcomes. The broad purpose of this study was to allow and facilitate ongoing research at UC San Diego into the mechanisms of failure of joint replacements in general.

Contains reports on four research projects., Office of Scientific Research and Development (OSRD) OEMsr-262

Contains reports on four research projects., Office of Scientific Research and Development (OSRD) OEMsr-262