Outsource or In House?

I’m sure no one will be surprised to hear that many services in acute care and outpatient settings are outsourced to individuals or organizations who specialized in certain tasks or services. One of these outsourced services include vascular access device insertion, in particular PICC insertions.

There are several independent companies and/or  individuals who provide PICC insertion service, many of them are my nursing colleagues. PICC insertion services/companies are usually nursing based organizations and are (or employ) nurses with  excellent technical knowledge and skills in PICC insertion. They use state of the art ultrasound equipment and catheter technology giving them a high success rates of insertion and positive patient satisfaction. . They are experts in what they do and no doubt can easily give a hospital and other healthcare organization a “turn key” PICC service.

On the other hand, there are numerous in house PICC teams, comprised of nurses who are employed by the hospitals/healthcare organizations. They are nurses who are experts in infusion therapy and vascular access and have the same excellent technical knowledge and skills in PICC insertion.  You will find that large hospital systems have dedicated PICC teams with the same ultrasound equipment and insertion success rates as the external PICC service. Small to medium hospitals also have PICC experts but their responsibilities may include other nursing or patient care related activities. In some areas, these PICC teams or nurses are under nursing services while others are part of radiology services. One of the biggest challenges in establishing an in house PICC team is finding qualified PICC  nurses and the financial ability to purchase expensive equipment such as ultrasound machine. Hospitals are not the only ones who utilize outsourced services, many home health agencies, home infusion companies, nursing homes and long term care facilities do as well. They have successfully outsourced their PICC insertion service which affords them the ability to accept patients with infusion therapy needs to their service.

The question I often get from managers  and CNOs is..which is more cost-effective – outsourcing or in house? A very tough question to answer and of course, it’s always about the bottom line. Expertise and experience comes with a high price and outsourced services are not cheap. On the flip side, employing highly skilled nurses and purchasing expensive equipment may not be cost effective  either. Many external PICC insertion  services claim they have saved  hospitals large sums of money using their service. (no public data available)  The cost (and or savings) will have to be analyzed and determine what’s best for your organization and your patients. Patients are happy when they get an expert who can insert then IVs in one stick!

So to the managers and CNOs – do your homework and understand what your short and long term goals are for your PICC service. Using a readily available service is very tempting because it is so easy. Sometimes it is cost effective to use a PICC service, sometimes it is not depending on your organization. Identify who has the best quality, good outcomes, and prompt service. Establish an honest working relationship with the PICC service  especially if outsourcing is only temporary and  your goal is to build you own PICC team. PICC insertion service is a business and no one wants to lose income.  If you have a PICC team, establish performance measures that will help you justify the team and monitor your contribution to patient care and oh, of course….the bottom line.

NOTE: While I insert and train nurses on PICC insertion, I am not in the PICC insertion business nor am I encouraging or discouraging the use of their services.

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