(C1) Improving Hospital Quality of Care and Outcomes of Patients with PICCs: The Michigan MAGIC Story

This session will present the journey of 69 hospitals working together through the Michigan Hospital Medicine Consortium (HMS) to reduce PICC-related complications by promoting appropriate device use. Since 2013, the collaborative has been collecting and sharing robust patient-level data to guide quality improvement (QI) and inform best practices. As a result, rates of PICC use for short-term, with multiple-lumens, and in patients with advanced chronic kidney disease have all declined. Importantly, rates of PICC-related thrombosis, bloodstream infection and catheter occlusion have also declined. In this session, discuss how interventions, such as benchmarking and incentivizing hospital performance, engaging physician champions, facilitating collaboration, and implementing a web based PICC QI toolkit have led to improvements. Finally, we will describe next steps for the work, including focusing on vascular access teams, oncology and critical care patient populations.

Through partnerships with multi-disciplinary stakeholders, HMS represents a unique model for a large-scale effort to improve clinical practice at diverse hospitals, including small and rural hospitals. HMS participating hospitals collected and shared patient-level data to evaluate practice patterns around PICCs, identify areas for improvement, and track performance trends over time. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) was implemented to prevent catheter-related complications, such as catheter occlusion, blood stream infections and venous thrombosis. Analyses of HMS data have resulted in robust insights around PICC practice and have been shared in peer-reviewed medical literature. HMS has also developed a web based PICC QI toolkit and provided expert resources for participating hospitals.

During this session, we will describe our collaborative experiences and lessons learned. We will discuss 1) overcoming barriers to PICC QI, 2) using data to drive changes in clinical practice, 3) implementing interventions, and 4) engaging stakeholders (including vascular access teams) in change management.

We will also share our collaborative-wide performance and outcomes data, including the results of our analysis in 2022 that showed significant improvements in appropriate PICC use, and significant reductions in catheter-related complication rates. Moreover, we demonstrated a substantial savings benefit despite the cost of this large-scale, multi-hospital effort.