The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) is an evidence-based series of recommendations that provide guidance on how best to use, manage and care for vascular access devices. MAGIC is now being used in hundreds of hospitals across the nation, and many hospitals overseas.
But the question remains: does MAGIC work to improve patient safety?
Until recently, we all wanted to believe that it did. And belief was all we had...
But thanks to work by an inspirational physician and her team in a Michigan Hospital - now we know.
Dr. Lakshmi Swaminathan and her Vascular Access team led a real world "validation" study of MAGIC. Validation is a scientific process where a method or idea is removed from it's origin (or derivation) and makers and placed into a brand new environment to see if it "works" as designed. Often used for statistical models for prediction, validation serves to affirm that the method or research described does what is intended - while providing valuable insights about what worked and what didn't and why.
In an article published in this months British Medical Journal - Quality and Safety (BMJQS), Dr. Swaminathan and her team report findings following an interrupted time series implementation of MAGIC in their hospital. To ensure findings were rigorous, they compared their results to ten other hospitals involved in the Michigan Hospital Medicine Safety collaborative - members of which are all focused on PICC use and outcomes. Thus, this study answers a specific and important question: among hospitals all working to improve safety and use of PICCs, does adding MAGIC make a difference compared to baseline?
The results: absolute rates of inappropriate PICC use dropped 26% more than other sites. Even after adjusting (or taking into account) patient complexity, hospital characteristics and other improvements - MAGIC improved PICC appropriateness by 13.8%. Importantly, PICC complications also decreased at a substantial rate (34%) compared to other hospitals (26%).
In short - MAGIC worked to improve PICC use and patient safety, and does so in ways more than other quality improvement work might suggest.
But (as with all real world research) there are some important caveats. First, although the authors used a robust study method, this was not a randomized trial. Thus, unmeasured factors might explain the difference across the study hospital vs. other control sites. Second, multiple components of MAGIC (an electronic tool, algorithm, educational roll out and nurse-based checklist, etc.) were used; which component was the most critical (or was the "active ingredient") is not known. And finally, although the reduction in complications was great and outpaced that of other hospitals - it wasn't good enough to achieve statistical significance for CLABSI and DVT. A larger study with more patients is needed to better understand this aspect.
So what does this study add? A few key things: first, we know from this work that implementation of MAGIC leads to improved PICC appropriateness and outcomes at a hospital other than where it was created. This is good news, as other hospitals (particularly community hospitals where this work was performed) that use MAGIC are likely to see similar benefits. Second, we know that MAGIC reduces complications from PICCs more than hospitals using other QI approaches: thus, hospitals struggling with occlusion, CLABSI and DVT might particularly benefit from using MAGIC. And finally - this study tells us that a vascular access team driven initiative can have huge payoffs to a hospitals bottom line. The implementation study in this facility was driven largely by the vascular access team - and saved hundreds of thousands of dollars for this facility in terms of reduced complications and device appropriateness. That's the bottom line for many C-suite level leaders - and that helps answer why we need more vascular access teams in the country! If you're interested in learning more, check out our CLABSI and DVT Cost Calculator for a savings estimate!
But perhaps the best part of this work is that it lives beyond a paper in a journal. The team at this hospital continues to experience great reductions in inappropriate PICC use (including in ICU patients) and outcomes (all VTE in the hospital) as shown in the slideshow below! And the patients are simply better for it! That, perhaps, is the greatest reward of them all!
You'll find some key components of the MAGIC study in the links below, and you'll find a copy of the published article there as well. Please do share widely and post your comments and feedback. And remember - the easiest way to use MAGIC is through the app - which is available for free here!
Get your MAGIC On!
Blogs written and edited by Vineet Chopra unless otherwise stated in the header. Guest blogs are identified accordingly.