Background: Peripherally inserted central catheters (PICCs) are often used as devices to extend intravenous treatment for hospitalized patients in post-acute settings. Variation between hospitals, indications for use, device characteristics, and outcomes for patients who receive PICCs and are discharged to skilled nursing facilities (SNFs) is not well known.
Methods: Trained abstractors used a standardized approach to collecting clinical data on a sample of patients who underwent PICC placement at one of 48 Michigan Hospital Medicine Safety (HMS) consortium hospitals. Patients discharged to SNFs between January 2015 to September 2018 were identified across all facilities. Discharge diagnoses, indication for PICC insertion, and device characteristics for patients discharged with PICCs to SNFs were assessed. Descriptive statistics were used to summarize findings.
Results: Among 41,143 hospitalized patients that received a PICC, 6757 patients (16%) were discharged with a PICC to a SNF. The most common discharge diagnoses for patients discharged to SNFs were infections (26%), diseases of the respiratory system (12%), and diseases of the skin and subcutaneous tissue (10%). The median duration of PICC dwell prior to discharge to a SNF was 3 days (IQR:1-7days). Among patients with a documented indication for PICC use, the antibiotic administration (65%), difficult venous access (14%) and TPN (4%) were the most common. However, 20% of patients did not have a documented indication for PICC use. Among antibiotics tracked, the most common medications included Vancomycin (21%), Zosyn (8%), and Cefepime (6%). PICCs placed in patients discharged to SNFs were most often single lumen devices (64%), although double (31%) and triple lumen (5%) catheters were also observed.
The proportion of patients discharged with a PICC to a SNF varied across hospitals from 4% to 54%. Additionally, indications for PICC use among those discharged to SNFs varied across hospitals: antibiotic administration (6-94%), venous access (0-73%) and TPN (0-16%). Hospital variation in the number of PICC lumens in patients discharged to SNFS was also noted: single lumen (11-94%), double (0-79%), and triple (0-31%).
Conclusions: While a substantial proportion of hospitalized patients are discharged with a PICC to SNFs, variation in indications and rates of PICC use for such transitions exist. Better understanding drivers of such variation and measuring post-acute outcomes of patients with PICCs in SNFs appears necessary.