NP/PA Critical Care House Officer Manager Cleveland Clinic Akron, Ohio
Purpose - What was the goal of the study?: To describe the development of an easy-to-use, multi-dimensional Return On Investment (ROI) model that can assist healthcare institutions to evaluate the economic benefits of NIR vein visualization technology. Application of the tool to a 500-bed hospital with a NIR vein visualization company (AccuVein Inc., Medford, NY) is presented.
Background - What was the problem? Why was it important?: Nearly 90% of inpatients will require a peripheral intravenous catheter (PIVC) during their hospitalization. [1, 2] On average, 1.37-2.35 attempts are required to place each PIVC, [3, 4] and up to 90% fail prior to intended removal, requiring replacement.  The average cost of first attempt PIVC placement is roughly $28 to $35, and this cost increases exponentially with repeated access attempts.  Each PIVC attempt failure is associated with increased supply and staff costs. Reducing PIVC attempts could contribute to cost savings. [2,4,6,7] For example, at an 867-bed, Level 1 trauma center with approximately 105,000 patients entering the emergency department (ED) annually; achieving a 96% first-attempt success rate resulted in cost savings of $3,376 per bed per year, or $2.9 million annually.  NIR vein visualization technology has been shown to improve PIV assessment for cannulation, decrease the overall procedure time, and decrease the number of required attempts. [8-10] However, there is limited data on the cost effectiveness and financial feasibility of the widescale adoption of NIR vein visualization technology.
Results - What were the findings?: An interactive ROI tool was designed to estimate the finance and resource implications of the widescale adoption of NIR vein visualization technology. The tool is based on a comprehensive synthesis of the literature that informed the development of algorithms applied. One use case was a 500-bed hospital with an existing total of four NIR devices and a utilization rate of 25%. The hospital explored the opportunity to purchase 46 additional NIR devices, requiring a one-off investment of $322,000 and no ongoing ownership costs. The ROI tool estimated that that at a utilization rate of 25%, annual hospital cost and time savings would be >$1 million with 1667 staff hours saved annually. Furthermore, annual supply savings were estimated as >$35,000; annual staff savings as >$930,000; annual escalation avoidance savings as $22,000; and annual infection avoidance savings as $29,000. The estimated total per unit savings were $20,532. If a 50% utilization rate is reached, the savings would double (>$2 million on hospital costs, 3334 staff hours saved annually, >$70,000 annual supply savings, >$1.8 million staff savings etc.).
Conclusions - What do the final outcomes mean?: Safe, efficient, and effective PIVC placement is critical to providing high-quality care in the post COVID19 era. First-attempt success can be optimized with the assistance of NIR vein visualization technology, which decreases overall procedure time, the number of required attempts and costs. This ROI tool can be used to evaluate the financial impact of investment in NIR vein visualization technology and demonstrate any potential cost savings. A key component of successful adoption of NIR vein visualization technology is ensuring that devices are readily accessible, and that the device is routinely used as an assessment tool rather than an escalation tool.