Clinician Reduces Skilled Nursing Treatment Cost – Nurse Clinicians in Action 32

Clinician Reduces Skilled Nursing Treatment Cost describes how a patient in a Skilled Nursing Facility needed fluid for dehydration, but her difficult IV access (DIVA) condition resulted in multiple failed attempts at placing a Peripheral IV (PIV) by the local, on-site treatment team, requiring the treating physician to order a Midline. Nurse Clinicians in Action is a spotlight series highlighting some of the interesting cases that Vascular Wellness clinicians have encountered and participated in treatment. These cases involve challenging situations or intriguing clinical presentations and may involve more than one Vascular Wellness clinician, as our clinicians have the ability to consult each other while in the field, as well as an on-call Clinical Administrator via a HIPAA (Health Insurance Portability and Accountability) compliant communication app. In addition, our extensive training program and diverse client base, including Level 1 Trauma Centers, Short Term Acute Care Hospitals, Long Term Acute Care Hospitals, and Skilled Nursing Facilities, provide our clinicians with a wide array of clinical experience and why we believe our clinicians, as a group, are the most experienced and best trained and supported vascular access clinicians.

Clinician Reduces Skilled Nursing Treatment Cost

– Clinical Case

A patient in a Skilled Nursing Facility who recently had hip replacement surgery was experiencing a temporary reduction in mobility, which made the patient concerned about their ability to get out of bed regularly to use the bathroom. As a result, the patient wasn’t drinking as much as needed and became dehydrated, which is quite common with aging patients. Vascular access was needed to administer fluid to address the dehydration. The physician ordered two liters of intravenous fluid for the patient via a peripheral IV (PIV), which is a common and typically straightforward course of therapy for treatment.

Unfortunately, the patient had suffered some complications from the hip replacement surgery at the acute care hospital, which required an antibiotic that is known to be harsh on veins. The hospital did not place a longer-term vascular access device, which usually was indicated for this particular antibiotic, and as a result, the patient’s veins were now depleted. Multiple staff members at the Skilled Nursing Facility attempted to place a PIV, but none were successful. The staff nurses informed the physician that the patient’s veins were too difficult to cannulate, and requested that a midline be ordered to administer the fluid. The physician, assuming that a PIV was no longer appropriate due to the multiple attempts, contacted Vascular Wellness and ordered a midline.

Clinician Reduces Skilled Nursing Treatment Cost

– Diagnosis and Treatment

The Vascular Wellness clinician arrived within 90 minutes and performed a pre-procedural assessment. While examining the patient, the clinician learned that the veins could be felt with palpitation even though they were not visually prominent, and determined that a PIV could be successfully placed, avoiding the more invasive and likely unnecessary procedure of placing a Midline. The advanced vascular access specialist conferred with the ordering physician and expressed confidence in being able to start the less-expensive but clinically appropriate PIV, and that the more invasive and costly Midline would not be necessary for the ordered therapy. The physician concurred, and the Ultrasound-Guided PIV was placed right away and without difficulty.

Vascular Access Specialists

– Key Points

On the surface, it may appear safe and cost effective to opt for a more transaction-based, basic mobile PICC company and not Vascular Access Specialists, but when faced with cases like this one (as well as in even straightforward patient cases), the reality is that it can negatively impact patients’ recovery and outcomes, and often costs facilities more in the long run. In this case, had the Skilled Nursing Facility chosen an inferior PICC service as compared to Vascular Wellness, the more expensive Midline would likely have been placed because most mobile PICC company nurses are not as extensively trained and experienced in pre-procedure patient review and vein visualization, and they are less likely to achieve less invasive and costly vascular access (e.g., a PIV) in DIVA patients where vascilature is compromised.

Vascular Wellness is often called after a less experienced PICC company was unable to achieve vascular access, resulting in expenses for two separate procedures (and possibly multiple attempts) rather than one. Additionally, because Vascular Wellness clinicians are vascular access specialists, we can pivot if needed and insert advanced lines such as Internal Jugulars, Mid-Thigh Femorals, Axillaries and more at the bedside during the same visit. As a result, Skilled Nursing Facilities are able to avoid both unnecessary transportation expenses to gain vascular access in difficult or complex cases and the possibility of losing their resident to a long hospital stay, potentially due to a hospital acquired infection, and creating patient and family dissatisfaction.

Most mobile PICC companies use 1099 contract nurses who are paid on a per-procedure model in which the contract nurse is paid more for more invasive procedures (vs. W-2 salaried employees with Vascular Wellness). This can result in a potential clinical conflict of interest involving compensation, and more rushed interactions and less time spent with patients to assess the medical history, future planned or anticipated medical procedures (in order to preserve veins), and to ensure the right line is placed, even if that means stepping down to a less invasive and less costly procedure. As Vascular Access Specialists, Vascular Wellness delivers hospital-quality vascular access to patients and their Skilled Nursing Facilities because, unlike many of our competitors, our nurse clinicians are Hospital-Credentialed, Skill-Verified, Board-Certified and Insured, and undergo extensive and continuous training so they can provide superior clinical services from patient assessment to the vascular access device placement, as in this case.  Vascular Wellness invests in its employees significantly more than other mobile PICC companies invest in their 1099 contractors, as would be expected.  

Having a trusted mobile and on-call vascular access partner whose expertise is demonstrated through experience in placing hundreds of thousands of lines with a 98% success rate and 0% insertion-related infection rate across all lines is a win-win for the patient and the facility. Our focus, dedication, and expertise means that medical teams often rely on us to consult with them regarding the best vascular access device for the patient’s needs. This holistic, patient-centered approach to vascular access is beneficial to all stakeholders, and it helps ensure placement of the clinically appropriate line the first time. As a result, our patients have fewer complications and more favorable outcomes, and these patients are more satisfied with the facility where they are receiving care and treatment. Our patients also avoid Delay Cascades, the concept that describes how delays in initial diagnosis and/or treatment can cause increased length of stay, worsening patient condition, antibiotic resistance, decreased patient satisfaction, and wasting of clinical resources (see References below).

References regarding “Delay Cascade”

1. Heart & Lung. Volume 49, Issue3, Page 273-286, May-June 2020
2. Journal of Infusion Nursing. 43(4): p222-228, July-August 2020
3. Journal of the American College of Emergency Physicians Open.  2020 Dec; 1(6): 1660–1668

If you require Vascular Access or want to learn more, speak to the team at Vascular Wellness today.  For the latest articles and insights, follow us on LinkedIn, Facebook, Twitter, YouTube, and Instagram.

Vascular Wellness provides:
(1) Comprehensive vascular access services to North Carolina, South Carolina, and Virginia;
(2) Customized vascular access services to Tennessee, Georgia, and West Virginia; and
(3) Support vascular access services to Pennsylvania, Ohio, and Kentucky.