Background: Vascular access selection requires comprehensive clinical information and standardized decision-making criteria. The DAV-Expert algorithm supports device selection; however, its application in clinical practice requires the necessary information to be available at the time of referral. The completeness of information provided in vascular access requests has been poorly investigated. Objective: To assess the completeness of information required for application of the DAV-Expert algorithm using a Missing Score, and to investigate factors associated with request assessability, the need for telephone-based information completion, agreement between the requested and recommended vascular access device, and waiting times. Methods: A prospective, single-center observational study was conducted at the Vascular Access Team of the AST of Macerata, Italy, between September and November 2025. Consecutive requests for new vascular access device placement in adult patients were analyzed. The Missing Score (0–5) quantified the absence of five information domains relevant to DAV-Expert application: type and duration of therapy, venous status, care setting, and clinical context. Outcomes included request assessability based on the information originally provided, agreement between the requested and recommended device, the need for telephone-based information completion, and waiting times. Results: Of 608 identified requests, 589 were included in the analysis. Overall, 65% had a Missing Score ≥3; no request was fully complete, and the expected duration of therapy was missing in all cases. Only 21 requests (3.6%) were immediately assessable according to DAV-Expert criteria. The type of infusion therapy was the factor most strongly associated with request assessability (OR, 14.26; 95% CI, 5.68–39.10; P<0.001). Agreement between the requested and recommended device was substantial (κ=0.723; P<0.001). Telephone-based information completion was required in 96.6% of cases and was more frequent among incomplete requests (OR, 3.68; 95% CI, 1.44–9.36; P=0.004). Waiting times were longer for central venous devices, scheduled requests, and requests originating from oncology units. Conclusions: The main process-related criticality appears to concern the availability and transmission of information required for clinical assessment rather than the ability to orient device selection appropriately. The systematic absence of treatment duration identifies a particularly critical information gap, while the high frequency of telephone-based information completion indicates a substantial additional workload related to information retrieval. A structured, information-system-integrated referral process could improve information completeness, traceability, and decision-making efficiency and provide the basis for an electronic model incorporating DAV-Expert criteria. Keywords: vascular access; vascular access device selection; DAV-Expert; Vascular Access Team; information completeness; clinical decision-making; patient safety; process improvement.
Introduzione: La selezione dell’accesso vascolare richiede informazioni cliniche complete e criteri decisionali condivisi. Il DAV-Expert supporta la scelta del dispositivo, ma la sua applicazione nella pratica clinica presuppone la disponibilità delle informazioni necessarie al momento della richiesta. La completezza informativa delle richieste di accesso vascolare è tuttavia poco esplorata. Obiettivo: Valutare la completezza delle informazioni necessarie all’applicazione del DAV-Expert mediante Missing Score e analizzare i fattori associati alla valutabilità della richiesta, la necessità di integrazione telefonica, la concordanza tra dispositivo richiesto e indicato e i tempi di attesa. Materiali e metodi: Studio osservazionale prospettico monocentrico condotto presso il Team Accessi Vascolari dell’AST di Macerata tra settembre e novembre 2025. Sono state analizzate consecutivamente le richieste di nuovo impianto in pazienti adulti. Il Missing Score (0–5) valutava l’assenza di cinque informazioni rilevanti per il DAV-Expert: tipo e durata della terapia, patrimonio venoso, setting di utilizzo e contesto clinico. Sono state considerate la valutabilità della richiesta sulla base delle informazioni originarie, la concordanza tra dispositivo richiesto e indicato, la necessità di integrazione telefonica e i tempi di attesa. Risultati: Su 608 richieste identificate, 589 sono state analizzate. Il 65% presentava un Missing Score ≥3; nessuna richiesta risultava completa e la durata prevista della terapia era assente in tutti i casi. Solo 21 richieste (3,6%) erano immediatamente valutabili secondo i criteri DAV-Expert. Il tipo di terapia infusionale rappresentava il principale fattore associato alla valutabilità (OR=14,26; IC95% 5,68–39,10; p<0,001). La concordanza tra dispositivo richiesto e indicato è risultata sostanziale (κ=0,723; p<0,001). Nel 96,6% dei casi è stata necessaria un’integrazione telefonica, con maggiore frequenza nelle richieste incomplete (OR=3,68; IC95% 1,44–9,36; p=0,004). I tempi di attesa sono risultati maggiori per i dispositivi venosi centrali, le richieste programmate e quelle provenienti dall’area oncologica. Conclusioni: La principale criticità del processo sembra riguardare la disponibilità e la trasmissione delle informazioni necessarie alla valutazione, più che l’orientamento verso il dispositivo appropriato. L’assenza sistematica della durata della terapia identifica un elemento informativo particolarmente critico, mentre l’elevato ricorso all’integrazione telefonica documenta un rilevante lavoro aggiuntivo di recupero informativo. Una richiesta strutturata e integrata nel sistema informativo potrebbe migliorare completezza, tracciabilità ed efficienza del processo decisionale e costituire la base per un modello informatizzato integrato con i criteri DAV-Expert. Parole chiave: accesso vascolare; scelta accesso vascolare; algoritmo DAV-Expert; Team Accessi Vascolari; completezza informativa; processo decisionale clinico; sicurezza paziente; miglioramento del processo.
Accessi vascolari e applicabilità DAV-Expert. Studio osservazionale prospettico monocentrico
ATTACCALITE, CHIARA
2025/2026
Abstract
Background: Vascular access selection requires comprehensive clinical information and standardized decision-making criteria. The DAV-Expert algorithm supports device selection; however, its application in clinical practice requires the necessary information to be available at the time of referral. The completeness of information provided in vascular access requests has been poorly investigated. Objective: To assess the completeness of information required for application of the DAV-Expert algorithm using a Missing Score, and to investigate factors associated with request assessability, the need for telephone-based information completion, agreement between the requested and recommended vascular access device, and waiting times. Methods: A prospective, single-center observational study was conducted at the Vascular Access Team of the AST of Macerata, Italy, between September and November 2025. Consecutive requests for new vascular access device placement in adult patients were analyzed. The Missing Score (0–5) quantified the absence of five information domains relevant to DAV-Expert application: type and duration of therapy, venous status, care setting, and clinical context. Outcomes included request assessability based on the information originally provided, agreement between the requested and recommended device, the need for telephone-based information completion, and waiting times. Results: Of 608 identified requests, 589 were included in the analysis. Overall, 65% had a Missing Score ≥3; no request was fully complete, and the expected duration of therapy was missing in all cases. Only 21 requests (3.6%) were immediately assessable according to DAV-Expert criteria. The type of infusion therapy was the factor most strongly associated with request assessability (OR, 14.26; 95% CI, 5.68–39.10; P<0.001). Agreement between the requested and recommended device was substantial (κ=0.723; P<0.001). Telephone-based information completion was required in 96.6% of cases and was more frequent among incomplete requests (OR, 3.68; 95% CI, 1.44–9.36; P=0.004). Waiting times were longer for central venous devices, scheduled requests, and requests originating from oncology units. Conclusions: The main process-related criticality appears to concern the availability and transmission of information required for clinical assessment rather than the ability to orient device selection appropriately. The systematic absence of treatment duration identifies a particularly critical information gap, while the high frequency of telephone-based information completion indicates a substantial additional workload related to information retrieval. A structured, information-system-integrated referral process could improve information completeness, traceability, and decision-making efficiency and provide the basis for an electronic model incorporating DAV-Expert criteria. Keywords: vascular access; vascular access device selection; DAV-Expert; Vascular Access Team; information completeness; clinical decision-making; patient safety; process improvement.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/28945