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

Madeleine Whalen, Barbara Maliszewski, Rebecca Sheinfeld, Heather Gardner, Diana Baptiste

Research output: Contribution to journalArticle


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. Unlabelled Box Contribution to Emergency Nursing Practice • Peripheral intravenous (IV) catheter placement is a quintessential nursing task. Delays in establishing IV access can lead to risks to patient safety.• Difficult venous access is a common issue, and improving venous access approaches can lead to tangible gains in patient and staff satisfaction, as well as emergency department workflow.• The implementation of a dedicated difficult venous access team can generate a significant decline in the time needed to obtain IV access for critical diagnostics and medical interventions.

Original languageEnglish (US)
Pages (from-to)478-482
Number of pages5
JournalJournal of Emergency Nursing
Issue number5
StatePublished - Sep 2018


  • Difficult venous access
  • Emergency department
  • Emergency nursing
  • Intravenous access
  • Patient safety

ASJC Scopus subject areas

  • Emergency

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