Implementing Catheter Guidance to Improve Appropriate Use and Patient Outcomes
Vineet Chopra, M.D., M.Sc.
Chair, Department of Medicine
University of Colorado School of Medicine
“As a hospitalist, I saw a gap in knowledge related to vascular access devices, especially peripherally inserted central catheters. AHRQ support is helping me to fill this gap, improving patient safety.”
Peripherally inserted central catheters (PICCs) are commonly used in hospitals and outpatient settings to draw blood, provide nutrition, or deliver intravenous (IV) medications such as chemotherapy or antibiotics. Despite their benefits, PICCs also carry potential risks, such as blood clots, infections or other complications. Developing protocols that enhance appropriate use and reduce complications is critical to ensuring patient safety.
Wide variation in PICC decision-making among hospitalists caught the attention—and concern—of Vineet Chopra, M.D., M.Sc., former Chief of the Division of Hospital Medicine at the University of Michigan Health System, Ann Arbor. “For example, I could come on service and a person would have a PICC placed for difficult access, and the next week someone would have a PICC for no clear reason,” he recalled. Despite trying to understand the clinical reasoning behind his colleagues’ decisions, “often there was no good reason for their choices,” Dr. Chopra said.
This dilemma led him to focus his health services research on how to improve the safety of PICC use and outcomes and share best practices with frontline clinicians. “The impetus for my work was the variation in and inappropriate use of PICCs combined with adverse events,” said Dr. Chopra. In 2014, AHRQ awarded Dr. Chopra a Mentored Clinical Scientist Award that enabled him to pursue this area of research and develop an expertise in the prevention of hospital-acquired complications, particularly those associated with the use of PICCs.
With this AHRQ support, Dr. Chopra led the development of a tool called Michigan Appropriateness Guide for Intravenous Catheters (MAGIC), a set of evidence-based criteria that define appropriate use for PICCs in hospitalized patients and identify predictors of PICC-related complications. “MAGIC gives providers the information they need to make an evidence-based decision for their patient, one that will render these devices appropriate and safe,” Dr. Chopra said. To date, MAGIC has resulted in improved outcomes, such as more appropriate PICC use and lower complication rates, for patients in hundreds of hospitals across the U.S. and the world.
Recently named the chair of the Department of Medicine at the University of Colorado School of Medicine, Dr. Chopra currently is conducting an AHRQ-funded large-scale implementation of MAGIC in which the tool is being tested in 50+ hospitals across Michigan. The project aims to improve appropriateness of PICC use; evaluate whether these improvements are associated with fewer complications; and identify which aspects of implementation led to the greatest change in appropriateness and complications.
If the results of this project show clear improvements, MAGIC potentially could change how clinicians make decisions about whether and how to use PICC lines, reduce PICC-associated infections, and improve patient safety. In the 50 hospitals testing MAGIC, 98 percent of them are seeing a statistically significant drop in complications. The project ends in May 2022.
In addition to chairing the University of Colorado’s Department of Medicine, Dr. Chopra also is a professor of medicine and serves as deputy editor of Annals of Internal Medicine. He also is a member of the American College of Physicians, the Society for Healthcare Epidemiology of America, the Society of General Internal Medicine, the Society of Hospital Medicine, and the Society to Improve Diagnosis in Medicine. In 2019, Dr. Chopra received the Distinguished Clinical and Translational Research Mentor Award from the Michigan Institute for Clinical Health Research. For his many contributions to improving patient safety, Chopra will be formally inducted into the American Society for Clinical Investigation during the summer of 2022.
Related AHRQ Resource:
Principal Investigator: Vineet Chopra, M.D., M.Sc.
Institution: University of Colorado School of Medicine
Grantee Since: 2017
Type of Grant: Various
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