We are a Midwest level I trauma center looking for information on Venous Access Teams (VAT) providing Peripherally Inserted Central Catheter (PICC) and Ultrasound (US) Peripheral Intravenous (PIV) services in a hospital setting. I’m looking for some information on how others have their PICC/IV teams structured? If you are involved in a VAT at your facility, I would appreciate you sharing the following information. Thank you!
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How is your VAT structured? Do you have a dedicated VAT, or some other structure?
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Are services brought to the patient’s room, or is the patient brought to an area for services?
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Are your services inpatient, outpatient or both?
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Do you provide ultrasound (US) peripheral intravenous (PIV) services in addition to Peripherally Inserted Central Catheters (PICCs)? Any other services?
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If you provide US PIV services, do you charge for the US placed PIV? If yes, what CPT code(s) do you use to charge?
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What are the hours your VAT services are available? What is your staffing model?
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Do you measure productivity? If yes, what do you measure? (ex: number of procedures, time, etc?).
Troy Betts, DNP, RN-BC
Email: [email protected]
I can speak to what is in t he literature and the evidence used to write the 2021 INS SOP. There are no studies that have evaluated one structure over another, however there are several studies that show reduction in time, costs, and resources for PIVC insertion and CVAD management. Several studies reported 24/7/365 comprehensive services beyond VAD insertion only. Those are the teams I have worked on, all 24/7, all doing much more than insertion including all dressing changes, port access, and some doing specialty drug administration like chemo. All services done in patient room. Both inpatient and outpatient services provided. Team should be set up as a revenue and cost center for budgetary purposes according to the 2021 INS SOP. An RN cannot send a bill for anything to any third party. An APRN can bill for professional services. Outpatient services are billed differently than inpatient. In patient is focused on cost containment because of DRGs and other capitated fee structures like HMOs. A finite amount for each patient admission based on diagnoses. Outpatient charges from the facility do not use DRGs. Talk to your financial office to learn about these outpatient codes. Teams should measure both productivity data (# of all procedures performed) and outcome data (infections, infiltration/extravasation, pneumothorax, nerve injury, thrombosis, phlebitis, etc.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you, Lynn! This is great information. We are currently 16/7 and are having some discussions about whether to pursue 24/7. Glad to see the INS update this month is addressing that. Great stuff! Thank you again, Troy
Troy,
We are a level 2 trauma center with 160 beds. We have a dedicated 24/7 VAT that places PICCs, USG PIVs, venipunctures, etc. throughout the hospital. Basically if we have a patient on campus who has difficult access we take our US machine to the patient and provide access. We respond to all codes and traumas and change ALL the PICC and CICC dressings on our in patient population. We also consult on difficult access patients and give recommendations to the provider on the most appropriate VAD.
We are a hybrid department in that we are “attached” to our infusion clinic that provides outpatient infusions; our VAT will place PICCs in those patients in our clinic. Many of our clinic nurses are vascular access nurses and can work infusion and place lines.
We run 3 vascular access nurses on days and two on nights, the VAT does not do anything with the infusion clinic patients but place the line.
We do measure productivity and that helps drive our department and our growth. We have a stat weight that provides guidance on our staffing.
We are considered a service to the hospital so we don’t get to charge for ultrasound guidance and we don’t have many CPT codes we get to use. We charge for our PICC insertions, venipunctures, and blood draws from CVCs.
Hope this helps!
Jessica
Jessica Newsom