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Make the case for a vascular access team by convincing with facts

You may have heard of a vascular access team (VAT) and its benefit to patient care, but you aren’t sure how to convince your executive board of the value to your patients and healthcare organisation? These teams are usually made up of multiple experts in vascular access and a skilled vascular access device (VAD) insertion service, guidance on best practice device selection, placement, care and maintenance.

Carr and Moureau define, “A [VAT] [a]s the grouping of healthcare professionals whose primary role is to assess, insert, manage, perform surveillance, analyse their service data and solve clinical concerns and where possible remove [VADs].”1

In this article, we will share what should be included in a successful VAT proposal and how to align the proposition with your healthcare organisation’s broader vision.

There is a growing body of evidence showing that implementation of a VAT may reduce:2–4

  • Length of hospital stay
  • Risk of IV complications
  • Cost of IV therapy
  • Time from referral to insertion

It is not always easy to change current practice, but tools are available to help you to take the step to convince key stakeholders that will make a significant impact on the healthcare organisation. A business case should help outline how the proposal will use the resources available to improve patient care and outcomes.5,6

More on this topic: The push to build vascular access teams in Ireland

Define your current vascular access practice

Before building a business case for a vascular access team, you will first need to define how vascular access is provided in your organisation and identify gaps that must be addressed.5–7

The BD team with its expertise in vascular access management experts can assist you in identifying areas of improvement by comparing current vascular access practice with guidelines, training healthcare professionals (HCPs) in clinical best practice and monitoring progress.

You may want to create a new VAT or expand an existing service.6 Be conscious of your organisation’s broader vision and how the future VAT will fit into it. 5,7 Determine what barriers may prevent you from setting up the service and how you plan to overcome them.5,7

Imagine the future vascular access team

Before writing your business case, you will want to choose a model for the VAT:1,7

  • Maybe, the future service will only insert peripherally inserted central catheters (PICCs).1,6
  • Maybe, it will primarily focus on patients with difficult venous access (DIVA).8
  • Maybe, it will primarily be responsible for central venous catheter (CVC) placement.8
  • Maybe, it will manage all aspects of VAD placement, care, maintenance and removal.

You should present three scenarios:5

  1. A full vascular access service (your preferred option)
  2. A part-time or partial vascular access service
  3. The current provision

Explain the clinical impact and the financial implications of not having a VAT.5,7

Estimate the cost of having a vascular access team

Consider HCPs who currently perform vascular access procedures and their level of experience and training. Then, calculate the cost of training existing staff while hiring new staff and training them.5 Next, evaluate the equipment required for the VAT and estimate the cost.5,7 Consider whole-life costs when considering different options for equipment.7

The National Institute for Health and Care Excellence (NICE) in the United Kingdom examined the evidence comparing the BD Sherlock 3CG™ Tip Confirmation System with alternative technologies for catheter tip guidance and confirmation.9

The NICE medical technologies guidance (MTEP) states that the BD Sherlock 3CG™ Tip Confirmation System provides benefits to patients in avoidance of routine confirmatory X-rays and immediate release of PICC for start of therapy; to staff in increasing confidence during placement and provided cost efficiencies for healthcare organisations.9–11

The NICE MTEP guidance can be found via the NICE website and provides cost data and clinical evidence that will be useful for writing a business case.9,11 Finally, the future VAT may also generate revenue for your organisation, thus offsetting potential costs.5

Consider vascular access techniques and locations

Another consideration for your business case is how and where the insertion procedure will be conducted. Specify the equipment and training that will be required at each step in the vascular access pathway.5

Describe the kind of technology your VAT will use when placing vascular access devices (VADs):5,7

  • Ultrasound guidance
  • Chest x-ray
  • Fluoroscopy
  • BD Sherlock 3CG™ Tip Confirmation System
  • Other tracking technology

It is also recommended that you determine the most appropriate location for VAD insertion procedures to be performed:7

  • At the bedside
  • In the radiology department
  • In operating theatres
  • Elsewhere

Choose key stakeholders for your vascular access team

It is important to bring a group of key multidisciplinary stakeholders together before and while you prepare your business case.6 They need to agree that the VAT is required and support you in this project.

Infection preventionists: These are one of the most important stakeholders because they will be able to provide data to support your business case and they will be able to support the VAT if you can show the positive impact of a VAT on infection rates.7,12

Pharmacists: They will be able to provide expertise on the composition of medications and the suitability of VADs for administration.6,7

Financial managers: They will be interested if they understand how the future service could generate income for your organisation and reduce the cost associated with all all complications.6,7

Senior manager: You will need the support of a senior manager (e.g., a clinical director or a nursing director), to help drive this proposal at the upper management level.5,7

Analyse risk

The business plan should show potential risks and how you can mitigate them.7 For instance, there may be tensions between different professions due to a perceived risk of deskilling, reskilling and role changes after training the new vascular access team.6

You will also need to demonstrate how the new service will affect other departments and not increase risk to the organisation as a whole.5

More on this topic: Development of a vascular access team: One size does not fit all

Measure the success of your future vascular access team

Defining and tracking key performance indicators (KPIs) is essential to show the successful implementation and positive impact of the VAT.5,7 These could include, but are not limited to: complication rate, catheter-related infection rate, catheter dwell time, length of stay, waiting time and successful VAD insertions and peripheral intravenous catheter (PIVC) first-attempt success rate.6,7

Along with clinical KPIs, it is important to measure cost and treatment pathway efficiencies to show how the future service could drive savings or even generate revenue for the organisation.5,7 A detailed business case requires time and effort to write and present to your organisation’s executive board to convince them of the need for a VAT,5 but BD supports your efforts to make vascular access management (VAM) a recognised discipline in healthcare.

References

  1. Carr PJ, Moureau NL. Specialized Vascular Access Teams. In: Moureau NL, ed. Vessel Health and Preservation: The Right Approach for Vascular Access. Springer International Publishing; 2019:59-65. doi:10.1007/978-3-030-03149-7_5
  2. Mussa B, Pinelli F, Cortés Rey N, et al. Qualitative interviews and supporting evidence to identify the positive impacts of multidisciplinary vascular access teams. Hosp Pract (1995). 2021;49(3):141-150. doi:10.1080/21548331.2021.1909897
  3. Ricou Ríos L, Esposito Català C, Pons Calsapeu A, et al. Implementation of a vascular access specialist team in a tertiary hospital: a cost-benefit analysis. Cost Eff Resour Alloc. 2023;21(1):67. doi:10.1186/s12962-023-00464-6
  4. Cortés Rey N, Pinelli F, van Loon FHJ, et al. The state of vascular access teams: Results of a European survey. Int J Clin Pract. 2021;75(12):e14849. doi:10.1111/ijcp.14849
  5. Hadaway L, Wise M, Orr M, Bayless A, Dalton L, Guerin G. Making the business case for infusion teams: the purpose, people, and process. J Infus Nurs. 2014;37(5):321-346. doi:10.1097/nan.0000000000000062
  6. Bolton D. Writing a business case for the expansion of service: expanding the IV therapy team, from start to finish. J Infect Prev. 2009;10(Suppl. 1):S27-S32. doi:10.1177/1757177409342337
  7. Barton A, Hayes A. Developing a Business Case for a Vascular Access Service. In: ; 2020.
  8. Jackson A. Development of a trust-wide vascular access team. Nursing Times. 2007;103(44):28-29.
  9. The Sherlock 3CG Tip Confirmation System for placement of peripherally inserted central catheters | 3 Clinical evidence. Published May 30, 2019. Accessed November 8, 2023. https://www.nice.org.uk/guidance/mtg24/chapter/5-Cost-considerations
  10. The Sherlock 3CG Tip Confirmation System for placement of peripherally inserted central catheters | 4 NHS considerations. Published May 30, 2019. Accessed September 11, 2023. https://www.nice.org.uk/guidance/mtg24/chapter/4-NHS-considerations
  11. The Sherlock 3CG Tip Confirmation System for placement of peripherally inserted central catheters | 5 Cost considerations. Published May 30, 2019. Accessed November 8, 2023. https://www.nice.org.uk/guidance/mtg24/chapter/5-Cost-considerations
  12. Perencevich EN, Stone PW, Wright SB, Carmeli Y, Fisman DN, Cosgrove SE. Raising standards while watching the bottom line: making a business case for infection control. Infect Control Hosp Epidemiol. 2007;28(10):1121-1133. doi:10.1086/521852

 

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