CREDIT: Cannulation Rates in the Emergency Department Intervention Trial. Improving patient care through the reduction of unnecessary cannula insertion in the Emergency Department

Ms Tracey Hawkins1, Dr Jaimi Greenslade1,2, Ms Maria Donohue3, Mr Matt Jensen, Dr  Julian  Williams1, Prof  Louise  Cullen1,2

1Queensland Health, Herston, Australia, 2University of Queensland, Brisbane, Australia, 3Griffith University, Nathan, Australia

Aim: Peripheral intravenous cannula (PIVC) are commonly placed in the emergency department (ED) and are often unused. Reducing unused cannula is important because inserting PIVC takes time, costs money and places the patient at risk for pain and infection. The aim of this study was examine whether a multi-modal education program could reduce PIVC placement in the ED.

Methods and Results: A prospective historical-case controlled study and cost analysis was conducted in a single tertiary ED in Brisbane, Australia. Patients were excluded if they were triage category one, had a PIVC inserted by ambulance services or transferred from another hospital.  Over a three month period, a multi-modal intervention including information sessions, posters, educational material, and change champions was implemented. PIVC placement and utilisation within 24 hours were evaluated for all eligible patients. A total of 4,173 participants were included in the analysis. PIVC were placed in 42.14% of patient pre-intervention and 32.38% post-intervention, a reduction of 9.76% (95% CI: -12.72 to -6.80%). PIVC usage within 24 hours of admission was 70.51% pre-intervention and 83.41% post-intervention, an increase of 12.86% (95% CI: 8.71-17.01%). Sixty-six patients were observed in the ED for cost analysis. The mean time per PIVC insertion was 15.2 ± 9.6 minutes. PIVC insertion cost including staff time and consumables per participant was $22.80.  Based on an observed 7.1% reduction the intervention resulted in a saving of $4,718 over the study period. If applied to all Australian EDs, an annual saving of $13.7 million could result.

Conclusion: The intervention reduced PIVC placement in the ED and increased use of those placed.  This program benefits patients and health services alike, with potential for large cost savings. This initiative has been selected as part of the “Choosing Wisely” campaign to continue the translation and implementation of the CREDIT program


Tracey Hawkins is a Registered Emergency Nurse who has been with the Emergency Research Group since its inception in 2008. She is a passionate clinician and research nurse, working in a dual role position combining her clinical role with her interest in clinically relevant research.  Tracey leads the departmental research nurse team providing the public face for patient recruitment, managing the behind-the-scenes responsibilities such as data collation and sample management.

Tracey started her nursing career in 1992 at the Central Queensland University Rockhampton and, after several years in infectious diseases and high dependency units at the Royal Brisbane and Women’s Hospital she headed to the UK where she worked as an emergency nurse for four years. On her return, she worked in rural and remote hospitals across Queensland.  Returning to the Department of Emergency Medicine at RBWH in 2001 and completing post graduate studies. She resides in Moreton Bay with her husband and two children.