A human factors engineering multimodal intervention results in sustained reduction in idle peripheral intravenous cannula insertions in the ED.

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.