Impact--improving patient access time: arterial cannulation.

Objectives: The overall aim of the project was for an advanced critical care practitioner (ACCP)to develop the clinical competency of arterial catheterisation. The study examined the impact of the intervention being performed by a different staff group member.

Design: The project took the form of service development, employing a service redesign route-map. The general strategy was a pre/post implementation audit providing a baseline,to evaluate the change.

Setting: The setting was an Adult General High Dependency Unit (HDU) in a large Teaching Hospital.

Outcome Measures: To reduce delay in arterial line insertion, whilst maintaining patient safety pre/post procedure, to a standard comparable to medical colleagues and to reduce the number of arterial punctures.

Results: Insertion complications reduced by 9% (1), with no increase in infection. Post procedure complications increased by 18% (2); however this occurred during medical team insertions, with no increase in infection during ACCP line insertions.Observing the whole service, both medical and ACCP insertions, mean length of wait, reduced from 4.3 hours to 1.2 hours: compared to less than 45 minutes during ACCP insertions. The total number of arterial punctures for each patient, prior to receiving an arterial line, decreased to less than three stabs.

Conclusion: All outcomes were achieved within ACCP practice, showing safe arterial line insertion by an ACCP in critically ill patients on HDU. Regular practice of the skill led to an improved technique and a reduction in delays.