Potential Centers for Medicaid & Medicaid Services (CMS) changes to tracking for hospital fungemia and bacteremia infection rates already have big implications for health systems. But a recent study on the economic implications of vascular access complications for providers adds new urgency to the discussion and a compelling reason why systems should support these changes.
In the Spring of 2022, CMS requested comments on a change to the National Healthcare Safety Network (NHSN) Hospital-Onset Bacteremia & Fungemia Outcome Measure. The proposal would essentially require tracking of all bacteremia – or bloodstream infections – within a hospital setting. Critically, for vascular access teams, this means tracking and recording bloodstream infections across all vascular access devices.
Currently, hospitals must only report bloodstream infections associated with peripheral inserted central catheter lines (piccs). That means systems can oftentimes hide infection rates by stepping down to midlines. Under the new measures, facilities will be forced to track on all vascular devices and report resulting infections.
Ultimately, including new metrics in the Hospital-Acquired Condition (HAC) Reduction Program will make it harder to obfuscate the real rate of infection and will likely lead to greater payment penalties for most systems. There will also be an anticipated efficiency drag on already-strained providers and an impact to overall reputation.
While the short-term horizon might look painful for systems, we believe this will eventually result in a commitment to better vascular access standards. With roughly 30% of all hospital patients receiving a vascular access device experiencing some type of complication (including bloodstream infections), this focus on improved standards is long overdue.
Even though the downsides of these proposed changes may seem daunting and are likely the reason why a number of systems are objecting to them, a new study published in the International Journal of Nursing and Healthcare Research provides a compelling financial reason to embrace this shift. This Integrative Review established that even a modest 50% reduction in vascular access complications result in nearly $1.8 million in savings annually for a typical 1,000-bed acute care facility ($560,000 for a 300-bed facility).
So, if these changes result in more accurate reporting – giving providers better visibility into the true scope of their problems – and lead to positive changes in vascular access standards, the potential payoff is enormous. Both in terms of value-based care reimbursements and the halo-effect of direct time and cost savings through the elimination of wider preventable complications like phlebitis and deep vein thrombosis (DVT).
In truth, the issue of hospital-acquired conditions has already been something of a focus with the pandemic leading to a 47% increase in hospital-acquired infections. Many systems are slowly starting to assess the robustness of their preventative programs. But with this new urgency, how can an already overburdened and understaffed hospital team succeed at improving these standards and reported metrics for all vascular access devices? Three areas in particular hold promise for rapid and meaningful positive change.
- Accuracy-improving technologies: Studies have shown that as high as 23% of ED patients meet the criteria for difficult venous access.Historically, these patients have frequently required “rescue” techniques, such as the placement of an external jugular line or CVC insertion when PIVs could not be obtained by landmark guidance. However, CVCs are associated with much more serious complications when compared to PIVs.
A range of new devices and technologies can quickly and dramatically improve both patient experience and clinical outcomes for these individuals. Ultrasound guidance has been proven to increase success rates and decrease complications and pain; with several studies finding ultrasound-guided PIV can reduce the need for CVC placement in up to 80% of patients. One-stick PIVs have also transformed vascular access for many patients – requiring only one device per patient per stay. Both of these innovations are critical as a patient’s experience with vascular access management informs their satisfaction for their overall hospital stay.
- Materials matter: The use of completely hydrophilic catheters that evade the natural defenses of the body by mimicking its natural chemistry can either diminish or nearly eliminate complications for vascular access procedures compared to traditional polyurethane-based devices. For example, a recent study published in the Journal of Infusion Nursing demonstrated that AVI catheters made from hydrophilic material showed a six times reduction in complications compared to traditional polyurethane catheters. Systems have already responded positively to the potential for simply swapping out materials but retaining procedural workflow to improve both patient experience and clinical outcomes. This is part of a broader medical device trend leveraging biomaterials that work in concert with the body to improve outcomes across a range of procedures.
- Procedural standardization: While completely overhauling the HAC prevention program may be too big of a task for many hospitals right now, there are small but incredibly impactful steps that can be taken to reduce catheter-related infections. One standard step such as scrubbing the needleless connector of the catheter with alcohol before infusing the medication can reduce the infection rate by 48-86%. Training teams on the latest best practices and enforcing adherence can lead to meaningful improvements in outcomes.
A system’s ability to innovate intelligently will play a key role in stamping out vascular access complications and reducing blood stream infections. Broader innovation in particular – like evaluating the materials from which the devices are made – and new technologies that improve the accuracy of procedures and ease the workflow will become more critical.
With increased value-based care adoption, the systems need to look beyond technologies that improve outcomes and save costs. They need to search for technologies that will dramatically transform – rather than incrementally improve – the outcomes to ensure hospital-acquired infections are a thing of the past.