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Abstract
Background The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) provides evidence-based criteria for peripherally inserted central catheter (PICC) use. Whether implementing MAGIC improves PICC appropriateness and reduces complications is unknown.
Methods A quasiexperimental study design to implement MAGIC in 52 Michigan hospitals was used. Data were collected from medical records by trained abstractors. Hospital performance on three appropriateness criteria was measured: short-term PICC use (≤5 days), use of multilumen PICCs and PICC placement in patients with chronic kidney disease. PICC appropriateness and device complications preintervention (January 2013 to December 2016) versus postintervention (January 2017 to January 2020) were compared. Change-point analysis was used to evaluate the effect of the intervention on device appropriateness. Logistic regression and Poisson models were fit to assess the association between appropriateness and complications (composite of catheter occlusion, venous thromboembolism (VTE) and central line-associated bloodstream infection (CLABSI)).
Results Among 38 592 PICCs, median catheter dwell ranged from 8 to 56 days. During the preintervention period, the mean frequency of appropriate PICC use was 31.9% and the mean frequency of complications was 14.7%. Following the intervention, PICC appropriateness increased to 49.0% (absolute difference 17.1%, p<0.001) while complications decreased to 10.7% (absolute difference 4.0%, p=0.001). Compared with patients with inappropriate PICC placement, appropriate PICC use was associated with a significantly lower odds of complications (OR 0.29, 95% CI 0.25 to 0.34), including decreases in occlusion (OR 0.25, 95% CI 0.21 to 0.29), CLABSI (OR 0.61, 95% CI 0.46 to 0.81) and VTE (OR 0.40, 95% CI 0.33 to 0.47, all p<0.01). Patients with appropriate PICC placement had lower rate of complications than those with inappropriate PICC use (incidence rate ratio 0.987, 95% CI 0.98 to 0.99, p<0.001).
Conclusions Implementation of MAGIC in Michigan hospitals was associated with improved PICC appropriateness and fewer complications. These findings have important quality, safety and policy implications for hospitals, patients and payors.
- critical care
- healthcare quality improvement
- hospital medicine
- nosocomial infections
Data availability statement
Given the quality improvement nature, data collected for the study will not be made available to others. However, our online toolkit is available to the public at https://www.improvepicc.com/implementation.html. More details can be found at https://mi-hms.org/quality-initiatives/peripherally-inserted-central-catheter-picc-use-initiative.
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Data availability statement
Given the quality improvement nature, data collected for the study will not be made available to others. However, our online toolkit is available to the public at https://www.improvepicc.com/implementation.html. More details can be found at https://mi-hms.org/quality-initiatives/peripherally-inserted-central-catheter-picc-use-initiative.
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Footnotes
Twitter @vineet_chopra
Contributors All authors contributed to the study design, data analysis and interpretation and manuscript drafting and revision.
Funding Blue Cross/Blue Shield of Michigan and Blue Care Network supported data collection at each participating site and funded the data coordinating centre but had no role in study concept, interpretation of findings or in the preparation, final approval or decision to submit the manuscript.
Provenance and peer review Not commissioned; externally peer reviewed.
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