Cannulation Rates in the Emergency Department Intervention Trial (CREDIT) – regional site implementation

Mrs Karen Smith1, Ms Sunayana Moriarty1, Prof Louise Cullen2, Ms Tracey Hawkins2, A/Prof Jaimi Greenslade2

1Queensland Health, Mackay Base Hospital, Mackay, Australia, 2Queensland Health, RBWH, Brisbane, Australia

Aim: It has been estimated that up to 10% of peripheral intravenous cannula (PIVC) inserted within the Emergency Department (ED) are not used. An education campaign, termed CREDIT, was designed to reduce the number of cannula inserted. This would have many potential benefits, including time for insertion, cost, risk of pain and infection for patients. The aim of this study is to evaluate CREDIT within a regional facility.

Methods and Results: A pre-post test study will be conducted in a single Regional ED in Mackay, Australia. The exclusion criteria consists of patients under the age of 18 years, Australasian Triage Scale (ATS) category one, having a PIVC inserted by Ambulance Services or inter-hospital transfers. The multi-modal CREDIT intervention will be implemented over a three-month period including information sessions, posters, educational material, and change champions. The primary outcome will be proportion of PIVC placed. We estimate 65% of our ED patients have a PIVC placed.  The secondary outcomes will be PIVC utilisation within 24 hours, ED length of stay and proportion of haemolysed blood tests. Our current haemolysis rates are 10% of all blood tests performed. Data from 150 patient’s pre-implementation and 150 post-implementation will be collected. The proportion of patients with PIVCs inserted will be compared across pre-and-post intervention groups. Secondary analyses will also compare the proportion of PIVCs inserted by diagnosis. Cost benefit will be considered as a final outcome measure.

Conclusion: This next phase of research is expected to validate the original research results and show a reduction in the placement of unused PIVC within the ED. With the probable reduction in insertions, it is likely there will be an equivalent cost saving and reduction in the risk of patient pain and infection. It is unclear as to the effect this trial will have on the ELOS; however, haemolysis rates should be reduced by the use of venepuncture over cannulation blood collection methods.


Karen Smith is a Registered Nurse who is driven to improve patient care. She works in a clinical role that allows her to combine her clinical knowledge and research passion to enhance clinical practice.

Karen started her nursing career in 2002, studying at Central Queensland University, Rockhampton. After a number of years of rural and regional nursing throughout Central Queensland, she commenced work in Mackay in 2010 and completed her Master of Nursing (Emergency) through Queensland University of Technology in 2017. This gave her the enthusiasm for research and improving clinical practice through evidence based research. She currently resides in Mackay with her husband and two children.