Outcomes of an Innovative Evidence-Based Practice Project: Building a Difficult-Access Team in the Emergency Department

J Emerg Nurs. 2018 Sep;44(5):478-482. doi: 10.1016/j.jen.2018.03.011. Epub 2018 Apr 25.


Problem: Difficult venous access is a common problem in health care-especially in the emergency setting-that relies on quick diagnostics to differentiate patient acuities and administer critical medications. The creation of a dedicated team to address difficult venous access (DVA) is a possible solution to the problems of delayed venous access, yet no studies have been published on implementing such a team in the emergency department.

Methods: This was a quasi-experimental study in an urban emergency department. Researchers performed chart audits of staff-identified patients with DVA to gather baseline data. A DVA team was subsequently implemented 16 hours a day, 7 days a week. Data were recorded on patients referred to the team and included time, number of IV attempts, and patient characteristics.

Results: Baseline data were collected on 53 patients, and postintervention data included 135 patients. The implementation of a DVA team decreased the mean lab order-to-lab completion time by 115 minutes (P < 0.0001). Decreases in the number of attempts were not statistically significant. Patients requiring increased numbers of IV attempts also had many common characteristics including history of multiple attempts, poor skin quality, and IV drug use.

Discussion: The use of a dedicated team for DVA reduces the lag time from physician orders to actionable diagnostics or administration of medication. A dedicated DVA technician is a concrete solution to threats of patient safety, as well as ED crowding, and has the potential to affect both patient- and department-level care.

Keywords: Difficult venous access; Emergency department; Emergency nursing; Intravenous access; Patient safety.

MeSH terms

  • Catheterization, Peripheral / methods*
  • Efficiency, Organizational
  • Emergency Service, Hospital / organization & administration*
  • Evidence-Based Practice
  • Humans
  • Organizational Innovation
  • Patient Acuity
  • Patient Care Team / organization & administration*
  • Time Factors
  • Treatment Outcome