Nudging to select single-lumen over multiple-lumen peripherally inserted central catheters (PICCs) in a large safety net system

• Published in: Infection control and hospital epidemiology Vol. 44; no. 9; pp. 1381 - 1385
• Main Authors: Alaiev, Daniel, Krouss, Mona, Israilov, Sigal, Musser, Lara, Talledo, Joseph, Mestari, Nessreen, Uppal, Amit, Madaline, Theresa, Cohen, Gabriel, Bravo, Nathaniel, Cervantes, Marialeah, Contractor, Daniel, Manchego, Peter Alacron, Chandra, Komal, Zaurova, Milana, Tsega, Surafel, Cho, Hyung J.
• Format: Journal Article
• Language: English
• Published: New York, USA Cambridge University Press 01-09-2023
• Subjects: Catheters; Critical care; Electronic health records; Hospitals; Internal medicine; Intervention; Length of stay; Original Article; Orthopedics; Patient safety; Quality improvement; Radiology; Safety; Surgery; Thromboembolism; Trends
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2022.306

Peripherally inserted central catheters (PICCs) are increasingly used for vascular access in inpatient settings. Compared to multilumen PICCs, single-lumen PICCs carry a lower rate of complications, including central-line-associated bloodstream infection and thrombosis. Despite this, multilumen PICCs are still overused.
This quality improvement initiative was implemented across 11 hospitals at New York City Health + Hospitals safety net system. The electronic health record (EHR) interventional radiology or vascular access team consultation orders were modified to allow for lumen choice, with default selection to a single-lumen PICC.
Average single-lumen PICC utilization increased by 25.5%, from 44.4% to 69.9% (
< .001). CLABSI rates had a nonsignificant reduction by 26.7% from 2.44 to 1.79 infections per month (
= .255). Among provider types in the postintervention period, single-lumen PICC utilization ranged from 67.7% for advanced practice providers to 82.4%-94.6% for physicians. Among provider specialties, utilization ranged from 31.8% for neurology to 97.7% for orthopedics. Additionally, there was large variation in pre- and postintervention differences in utilization by hospital.
We successfully increased single-lumen PICC utilization across all 11 safety net hospitals. This expands on previous work on improving single-lumen PICC use and use of default nudges in large, resource-limited settings. Further study is needed to examine variation among provider types, specialties, and hospitals.