Overview of the Study

Peripheral intravenous cannulas (PIVCs) cost Australian emergency departments (EDs) up to $594 million annually, with nearly $306 million spent on cannulas that are never used. Beyond this financial waste, unused cannulas contribute to environmental harm, consume an estimated 11,790 clinician days per year, and expose patients to avoidable risks, including bloodstream infections. Reducing unnecessary PIVC insertions is therefore not just a matter of patient safety—it’s an urgent healthcare and economic priority.

Professor Diana Egerton-Warburton, Director of Emergency Medicine Research at Monash Health, is a national leader in this space. In 2024, she and the Multidisciplinary PIVC Investigator Group launched a landmark five-year implementation science trial, supported by a $2.9 million Medical Research Future Fund (MRFF) grant. The goal: to improve PIVC practices in Australian EDs by reducing unnecessary insertions and enhancing patient care, with the ambitious aim of implementing best-practice guidelines in 50% of EDs nationwide.

The intervention has already demonstrated local effectiveness and is aligned with the Australian Commission on Safety and Quality in Health Care (ACSQHC) through its PIVC Clinical Care Standard and World Health Organization (WHO) guidelines for preventing intravascular catheter infections, targeting the elimination of PIVC-related bloodstream infections.

The study will be delivered through four interlinked work packages:

1. Clinical Effectiveness and Safety Trial
   A stepped-wedge, cluster-controlled trial will be conducted across 9 diverse EDs. Interventions will be introduced in phases every 6 months following a baseline period. We will assess PIVC insertion rates, usage, safety, and infection outcomes.

2. Co-Designed Adaptive Intervention
   Using validated implementation and evaluation frameworks, we will refine the intervention in partnership with stakeholders, building on previous successful models and aligned with ACSQHC standards and indicators.

3. Health Economic Evaluation
   A within-trial economic analysis will determine the cost-effectiveness of the intervention from both hospital and system-wide perspectives. This includes direct costs, downstream healthcare impacts, and the broader health and environmental “snowball” effects.

4. National Scale-Up and Engagement
   We will co-design implementation toolkits and leverage national engagement strategies—including a modified Delphi process and snapshot surveys. Supported by strong partnerships and consumer involvement, we aim to roll out the intervention to at least 50% of EDs nationally in a person-centred, cost-effective manner.

This research will generate high-level evidence to transform PIVC practices, reduce harm, and create long-term economic and environmental benefits for the Australian healthcare system.