title: Impact of a Surgeon-Led Peripherally Inserted Central Venous Catheter Team on Peripherally Inserted Central Venous Catheter-Related Complications and Costs.
abstract: BACKGROUND
  Peripherally inserted central venous catheters (PICCs) are popular for a broad range of indications. As with other forms of central access, PICC use can be associated with serious and potentially costly complications. In 2000, in response to the rising popularity of PICC use, a surgeon-led team was created to steward their placement. All requests were screened rigorously to ensure rational use. Our hypothesis was that creation of a dedicated PICC team would decrease inappropriate PICC placement, overall complication rates, and cost.
  
  
  METHODS
  The study was a retrospective review of prospectively collected data captured in the PICC team-maintained database between 2000 and 2013. The database was reviewed for PICC indications, reasons PICC requests were denied, and septic or thrombotic complications after PICC placement. To estimate cost savings, PICC supplies and each occurrence of blood stream infection (BSI) and thrombotic complication was assigned a cost on the basis of the available literature.
  
  
  RESULTS
  Between 2000 and 2013, 35,651 PICC placements were requested, of which 24,638 (69.1%) were approved, 22,157 (62.1%) immediately and 2,481 (6.9%) after initial refusal in view of further review of the indications. Most (95%) of the PICCs inserted were placed at the bedside within 1 d of approval. Blood stream infections occurred in 5.9% of patients and thrombosis in 2.7%. The attributable costs saved by declining placement of unnecessary PICCs, assuming the same proportions of patients would have developed a complication, could be as high as $5.4 million (M) in supplies, $7.77 M in avoided BSI and $2.25 M in avoided thrombotic complications, for a total savings of $15.44 M.
  
  
  CONCLUSIONS
  The implementation of a surgeon-led PICC team had a significant impact on the placement rate, reducing cost by supplies foregone and complications avoided. Cost savings related to PICC placement alone should be considered as the definite cost savings because of the judicious allocation of resources.
authors.affiliation: 1 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: Luise I M
authors.initials: LI
authors.lastname: Pernar
authors.affiliation: 1 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: Lindsay L
authors.initials: LL
authors.lastname: Wolf
authors.affiliation: 1 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: Anupamaa
authors.initials: A
authors.lastname: Seshadri
authors.affiliation: 1 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts.|2 Division of Metabolic Support, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: Vihas
authors.initials: V
authors.lastname: Patel
mesh_terms: D001900:Boston; D055499:Catheter-Related Infections / Q000191:economics / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000191:economics / Q000379:methods; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000191:economics / Q000379:methods; D017046:Cost Savings / Q000706:statistics & numerical data*; D016208:Databases, Factual; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007857:Leadership; D010348:Patient Care Team / Q000458:organization & administration*; D012189:Retrospective Studies; D066231:Surgeons