Events & training

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

June 22, 2020

You may have heard of vascular access teams (VATs) and the benefit to patient care but you aren’t sure how to convince your executive board of the value to the patients and organisation. These teams are usually made up of multiple experts in vascular access (VA) and provide guidance on device selection as well as the care and maintenance of your vascular access devices (VADs).

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 [vascular access devices (VADs)]2.”

In this article, you will learn what should be included in your proposal to make the case for a VAT and how to align it with your healthcare organisation’s broader vision. In a randomised controlled trial, it was found that intravenous (IV) catheters maintained by a dedicated VAT had a lower complication rate (7.9%) than those maintained by non-VAT staff (21.7%)1. If an IV catheter is removed without complications after treatment has been completed, costs are lower than if there are complications3.

It is not always easy to change current practice, but tools are available to help you to convince key stakeholders of the need for changes that will make a significant impact on your healthcare organisation. A business case can help outline how your proposal will use the resources available to improve patient care and outcomes3,4.

Define your current vascular access practice

Before building a business case for a VAT, you will first need to define how VA is provided in your organisation and identify gaps that must be addressed3-5. BD Vascular Access Management experts can assist you in identifying areas of improvement by comparing current VA practice with guidelines, training healthcare professionals (HCPs) in clinical best practice and monitoring progress.

You may want to create a new VAT or expand your existing one4. Be conscious of your organisation’s broader vision and how your future VAT will fit into it3,5. Determine what barriers may prevent you from setting up the service and how you plan to overcome them3,5.

Imagine your future vascular access service

Before writing your business case, you will want to choose a model for the VAT2,5.

  • Maybe, your future service will only insert peripherally inserted central catheters (PICCs)2,4.
  • Maybe, it will primarily focus on difficult vein access (DVA)6.
  • Maybe, it will primarily be responsible for central venous catheter (CVC) placement6.
  • Maybe, it will manage all aspects of VAD placement, care, maintenance and removal.

You should present three options3:

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

Explain the clinical impact and the financial implications of not having a VAT3,5.

Estimate costs

Consider HCPs who currently perform VA procedures and their level of experience and training. Then, calculate the cost of training existing staff while hiring new staff and training them3. Next, evaluate the equipment required for the VAT and estimate the cost3,5. Consider whole-life costs when considering different options for equipment5. The U.K. National Institute for Health and Care Excellence (NICE) has a webpage comparing the BD Sherlock 3CG™ Tip Confirmation System with other technologies for ultrasound vein visualisation and catheter tip guidance7. NICE found that the technology 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 organisations7,8. The webpage provides cost data and clinical evidence that can be used for writing a business case7,8. Finally, the future VAT may also generate revenue for your organisation, thus offsetting potential costs3.

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 VA pathway3.

Describe the kind of technology your VAT will use when placing vascular access devices (VADs)3,5:

  • Radiography
  • Electrocardiography
  • Ultrasound
  • Or other tracking technology

It is also recommended that you determine where VA will be carried out: at the bedside, in the radiology department, in operating theatres or elsewhere5.

Choose your key stakeholders

It is important to bring a group of key stakeholders together before and while you prepare your business case4. 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 rates5,9.

Pharmacists: They are a key stakeholder to collaborate with by providing expertise on which medications are recommended for which device4,5.

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 complications4,5.

Senior manager: You will need the backing of a senior manager (e.g., a clinical director or a nursing director), to help drive this proposal at the upper management level3,5.

Analyse risk

The business plan should show potential risk and how you can mitigate it5. For instance, there may be tensions between different professions due to deskilling, reskilling and role changes after training the new VAT4. You will also need to demonstrate how the new service will affect other departments and make sure this impact will not increase risk to the organisation as a whole3.

Measure success

In order to show how successful the implementation of this VAT will be, you will have to define key performance indicators (KPIs)3,5. 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 rate4,5. 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 organisation3,5.

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 VAT3, but we support you in your efforts to make vascular access management (VAM) a recognised discipline in healthcare.


#Business case #Vascular access #Vascular access service #Vascular access team #Vascular therapy


References

1. Soifer NE, Borzak S, Edlin BR, Weinstein RA. Prevention of peripheral venous catheter complications with an intravenous therapy team: a randomized controlled trial. Arch Intern Med. 1998;158(5):473-477.

2. Carr PJ, Moureau NL. Specialized Vascular Access Teams. In: Moureau NL, ed. Vessel Health and Preservation: The Right Approach for Vascular Access. Cham: Springer International Publishing; 2019:59-65.

3. 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.

4. 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.

5. Barton A, Hayes A. Developing a Business Case for a Vascular Access Service. Presented at: Multidiscliplinary Advanced Course on Vascular Access (MACOVA) 2020; 16 January, 2020; Edinburgh, United Kingdom.

6. Jackson A. Development of a trust-wide vascular access team. Nursing Times. 2007;103(44):28-29.

7. The Sherlock 3CG Tip Confirmation System for placement of peripherally inserted central catheters | 3 Clinical evidence. U.K. National Institute for Health and Care Excellence (NICE). https://www.nice.org.uk/guidance/mtg24/chapter/3-Clinical-evidence. Published 2015. Updated 30 May 2019. Accessed 29 April 2020.

8. The Sherlock 3CG Tip Confirmation System for placement of peripherally inserted central catheters | 5 Cost considerations. U.K. National Institute for Health and Care Excellence (NICE). https://www.nice.org.uk/guidance/mtg24/chapter/5-Cost-considerations. Published 2015. Updated 30 May 2019. Accessed 29 April 2020.

9. 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.

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