Understanding the Impact of DIVA in the ED
Patients with difficult intravenous access (DIVA) often face significant delays in emergency departments (EDs), impacting their treatment, imaging, and overall disposition. A recent study conducted at Ocala Regional Medical Center aimed to better understand the differences in treatment times and associated comorbidities between DIVA patients requiring ultrasound-guided intravenous (USGIV) access and non-DIVA patients. The findings shed light on the critical need for improved protocols and training to enhance patient care in community ED settings.
Why DIVA Matters for Patient Care
Intravenous (IV) access is a fundamental component of emergency medical care, necessary for obtaining laboratory measures, administering contrast for diagnostic imaging, and delivering life-saving therapies. However, a subset of patients—those with DIVA—experience significant challenges in IV placement, leading to delays in care. Factors contributing to DIVA include age, obesity, intravenous drug use (IVDU), and chronic medical conditions like end-stage renal disease (ESRD). These patients are often more prone to delays, resulting in prolonged ED stays and potentially worse health outcomes.
Study Design and Key Findings
The primary objective of this study was to characterize the differences in time to IV access, imaging, and disposition between DIVA and non-DIVA patients in a community ED. Additionally, the study sought to identify comorbidities associated with DIVA.
Conducted as a cross-sectional, observational analysis, the study included ED patients from September 2nd to September 31st, 2022. DIVA was defined as patients requiring USGIV access after two failed attempts at traditional IV placement. The study excluded patients under 18, trauma admissions, repeat visits, and those with missing data, resulting in a final sample size of 1,250 patients.
The study found that 5.8% of the patients were identified as DIVA, with these patients more likely to be female and to have histories of ESRD and IVDU. Specifically:
- ESRD: Patients with ESRD were 3.56 times more likely to be DIVA.
- IVDU: Patients with IVDU were 14.29 times more likely to be DIVA.
In terms of ED throughput:
- Time to Vascular Access: DIVA patients had significantly longer median times to achieve vascular access.
- Time to Contrast CT Imaging: Delays in obtaining IV access led to extended times for contrast-enhanced imaging.
- Time to Disposition: Overall disposition times were significantly longer for DIVA patients, highlighting a critical bottleneck in the ED process.
These delays emphasize the need for efficient and effective strategies to manage patients with DIVA, particularly in non-academic community EDs where resources and specialized training may be limited.
Why These Results Matter
The findings indicate that DIVA patients experience considerable delays in essential ED processes, which can negatively impact patient outcomes and satisfaction. The significant associations with comorbidities like ESRD and IVDU suggest that early identification and intervention for these patients could mitigate some of these delays. The study underscores the importance of robust training for ED staff in USGIV techniques, as well as the need for adequate equipment and resources.
How SonoSim Can Help Address the DIVA Challenge
SonoSim’s comprehensive ultrasound training can play a pivotal role in addressing the challenges identified in this study. By providing access to realistic, hands-on ultrasound training, SonoSim ensures that healthcare providers can develop the necessary skills to perform USGIV access effectively and efficiently.
Key features of SonoSim's training ecosystem include:
- Interactive Courses: Over 85 on-demand courses covering a wide range of ultrasound topics, including USGIV access.
- Hands-On Virtual Scanning: The SonoSimulator® offers realistic scanning practice with real patient cases, allowing learners to master the technique in a risk-free environment.
- Performance Tracking: Tools to monitor and assess learner progress, ensuring competency in ultrasound procedures.
Implementing SonoSim’s training in community EDs can help reduce delays associated with DIVA, improve patient outcomes, and enhance overall ED efficiency. By equipping more healthcare providers with USGIV skills, emergency departments can better manage patients with difficult intravenous access, ultimately leading to faster, more effective patient care.