PROJECT NAME: Utilization of Ultrasound for Central
Venous Line Insertion
Institution: UT Health Houston
Primary Author: Bela Patel MD
Secondary Author: Khalid Almoosa MD, Jeffrey Katz MD, Michael
Shabot MD
Project Category: Patient Safety
Overview: In the US, physicians insert more than 5 million central venous
catheters every year. Unfortunately, more than 15 percent of patients who receive
these catheters have complications. Mechanical complications are reported to
occur in 5 to 19 percent of patients and can be significantly reduced by use of
ultrasound to guide placement of these catheters. Up to 750,000 complications a
year may be reduced by standardizing line placement yet it is not considered a
practice standard in most institutions. We developed a program for a 10 hospital
system to incorporate ultrasound in placing all central venous catheters.
Aim Statement (max points 150): To increase ultrasound utilization for central
line placement to 80% or higher in 12 months in 10 hospitals.
Measures of Success: Increase in compliance with ultrasound use for line
placement in all 10 hospitals
Use of Quality Tools (max points 250): A Fishbone helped to identify barriers
to ultrasound use. Brainstorming with staff assisted in prioritizing areas for
improvement. Run charts were used to communicate compliance and distributed to all
hospital leaders. Mini - Root Cause Analysis (RCA) helped identify areas for
improvement. Control Charts tracked progress over time and identified the stability of
processes.
10 hospitals average utilization of ultrasound for central line placement .
Interventions (max points 150 includes points for innovation):
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Meetings conduced in hospital committees (Critical Care, Emergency
Medicine, Trauma, etc) and 10 hospital system committees (Critical Care,
Hospital Medicine, etc) to discuss evidence based literature, local rates and
complications and national society guidelines
Meetings conducted with key stake holders
Guidelines for all central lines to be placed by ultrasound passed by system
physician committees and by all medical executive committees
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Ultrasound machines purchased to support increased need
Multiple sessions for training for physicians held at all sites
March 2011 – all sites received adequate training and equipment
Compliance data widely distributed monthly
Non compliance data individually distributed to operators and leadership
Complication rates of pneumothorax without ultrasound presented at
leadership meetings and medical executive committees.
Awards given for 12 months of no pneumothoraces to hospitals
Results (max points 250):
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Compliance with ultrasound use for central line placement has increased to
over 80% at all 10 hospitals within 12 months (March 2011 – March 2012) of
training completion.
All hospital have sustained high level of utilization
8 of 10 hospitals have attained greater than 90% utilization compliance by
June 2012
4 of 10 hospitals have reached 0 pneumothorax rates for 12 months.
Revenue Enhancement /Cost Avoidance / Generalizability (max
points 200):
We did not calculate the financial effects of this intervention. Decreased rates of
line associated pneumothorax have been noted throughout the 10 hospital system
(4 of 10 hospitals have reached 0 pneumothorax rates for 12 months). Future CMS
funding reduction for complications and patient satisfaction should be considered.
Conclusions and Next Steps: We adopted ultrasound utilization for all line
placements to improve patient safety in a 10 hospitals (academic, community,
rural, specialty). Decreased line related complications have been observed
throughout the system. This project directly contributes to our and institution’s
overall goal of reducing patient harm and potentially decreasing hospital length of
stay, and reducing costs of care. Our goal is to sustain this practice in our
institution and healthcare system and share knowledge gained by this large
implementation with other healthcare organizations.