Table 1 DART³ outcomes. Outcomes, definitions, and data collection organised by RE-AIM domains

Patient and service level outcomes

Primary

First attempt insertion success in patients identified as DIVA

One needle puncture, by one inserter, to achieve successful insertion of a functional (can be aspirated/flushed) PIVC ²

Hospital-based assessments

Secondary

First attempt insertion success for all patients (regardless of DIVA status)

One needle puncture, by one inserter, to achieve successful of a functional (can be aspirated/flushed) PIVC ²

Hospital-based assessments

Number of attempts

Number of skin punctures to attempt PIVC insertion ³

Hospital-based assessments

Procedure outcome:

Successful PIVC insertion; time from PIVC referral to PIVC insertion (censored at 48 h); alternate device; alternate route (e.g., oral) ⁴

Hospital-based assessments

PIVC failure

Composite measure of local infection, primary bloodstream infection (BSI), occlusion, infiltration/extravasation, dislodgement (includes leaking), thrombosis and/or phlebitis ^{6 7}

Hospital-based assessments

Insertion/post-insertion complications

Bruising, haematoma, nerve injury, arterial puncture, or skin injury as well as the individual components of PIVC failure (above) ^{6 8}

Hospital-based assessments

PIVC dwell time

Time from PIVC insertion to PIVC removal (in hours) ⁶

Hospital-based assessments

PIVC necessity

PIVC used for fluids or medications within 24 h (excluding patients who require a prophylactic PIVC in situ as part of their treatment e.g., status epilepticus) ⁵

Hospital-based assessments

Incidence of blood stream infection

Cluster level routinely-collected rates of primary BSI and S. Aureus BSI ⁹

Hospital-based assessments

Economic outcomes

Cost-effectiveness

Direct and indirect healthcare costs to the health system, patients/carers: (time to insertion/therapy, cost of products, number of staff, staff time, costs of responding to failed insertion including cancelled appointments)

Hospital-based assessments

Implementation outcome- reach

Number of healthcare professionals attending Ultrasound training

Counts of clinicians attending ultrasound training

Hospital-based assessments

Number of staff accredited in ultrasound insertion

Per local ultrasound accreditation requirements

Hospital-based assessments

Implementation outcome—adoption

Healthcare provider engagement

Proportion of patients assessed using the DIVA vein assessment tool

Hospital-based assessments

Ultrasound adoption

proportion of DIVA patients with ultrasound used at the first, or any attempt

Hospital-based assessments

Patient/carer/parent satisfaction and pain with insertion procedure

0–10 numeric rating scale ⁶

Hospital-based assessments

Inserter (initial and/or successful inserter) satisfaction with escalation pathway

0–10 numeric rating scale ⁶

Hospital-based assessments

Attitude of healthcare providers with DIVA tools

Degree of acceptability of the DIVA tools by clinicians

Key stakeholder interviews

Implementation outcome - implementation

Fidelity

Degree that the DIVA tools are implemented as planned in original protocol

Key stakeholder interviews

Feasibility

Extent that the DIVA tools can be carried out in specific settings

Key stakeholder interviews

Outer context

Macro-level external factors including social, funding, and leadership

Key stakeholder interviews

Inner context

Micro-level internal factors including behaviours, feedback.

Key stakeholder interviews

Implementation outcome—maintenance

Sustainability of the intervention and effectiveness

First time insertion success at 3- or 6-month sustainability assessments

Hospital-based assessments

Satisfactory of stakeholders

0–10 numeric rating scale ⁶

Key stakeholder interviews

Financial sustainability

Explored in the cost-effectiveness analysis and qualitatively through interviews with executive stakeholders.

Key stakeholder interviews

Institutionalisation of

interventions

Concerned with sustaining social behavioural change

Key stakeholder interviews