Demand for patients to have Radiologically-guided lines, including Hickman Lines and PICCs, is met by a variety of service models within Acute Trusts. University Hospitals of Leicester (UHL) has an interesting and highly successful approach to meeting demand.
Demand for patients to have Radiologically-guided lines, including Hickman Lines and PICCs, is met by a variety of service models within Acute Trusts. Some service models are more successful than others and from time-to-time the issue of patients being delayed in their treatment or discharge whilst awaiting such lines is reported by the press, particularly when the delay has been determined at Inquest to have contributed to a patient’s death.
University Hospitals of Leicester (UHL) has an interesting and highly successful approach to meeting demand. In fact, their Nurse-led service, developed over a number of years, has been so successful that demand has significantly increased as they deliver the service to all patients who would benefit from a line insertion, rather than only carrying out the procedure for patients with high acuity.
In 2000, the UHL Hickman Line Service operated by Radiology had an 8 week waiting list, performing approximately 300 procedures per year. The Service was run by a single Consultant Interventional Radiologist, Dr Kim Krarup, assisted by a Sister working in Radiology. The Sister, Sharon Hubbard, asked if she could be trained to perform the procedures.
In 2014, Sharon is now the Lead Specialist Practitioner for Vascular Access and manages the Nurse-led Vascular Access Team. This 3 member nursing team (2.4 WTE and a Scrub Assistant) operates a Monday to Friday service in a dedicated room, performing in excess of 1300 procedures a year, including direct access referrals from local GPs, and undertakes sessions in neighbouring hospitals.
Their turnaround time, from the point of request to performance, averages less than 24 hours. In a typical week, Sharon and her team will perform a mixture of urgent lines and planned lines, including offering a service for haematology and oncology patients to have their lines installed at the optimal time for their treatment.
The University Hospitals of Leicester NHS Trust has one of highest Interventional Radiology Procedure counts per 100,000 Occupied Bed Days and per £100m turnover from all Trusts who participated in the NHSBN Radiology Project in 2014. This reflects both the high number of procedures undertaken as well as the impact that such procedures have on reducing bed days; already under average compared to their peers, UHL’s mean number of bed days per SPELL has fallen a further 2% in 2013/14. This service, therefore, makes a direct contribution to improved patient flows and reduced length of stay at the Trust.
A frequently audited service, Sharon and her team have a >90% success rate for placing lines and an exceptionally low complications rate (0.3%). Their service has reduced the overall burden on the Trust, enabling more patients to receive treatment in the Community, improved the speed at which patients can be safely discharged, reduced the demand on theatres and reduced screening (exposure) time to patients.
The team now trains Medical and Surgical trainees in the placement of lines, as well as nurses and other clinical staff in the efficient maintenance of lines.
Their gold standard service has been recognised following peer review with a Level 2 accreditation for Treatment of Gastrointestinal Failure.