Improving Patient Care Through Quality Improvement Initiative: A Study of Knowledge, Practice, and Skill Among Interns and Residents on Arterial Puncture for Arterial Blood Gas Analysis at a Tertiary Teaching Hospital in Rural Gujarat

Aims and Background: Arterial Blood Gas Analysis (ABG) is an indispensable diagnostic tool offering swift and comprehensive insights into a patient’s ventilation, gas exchange, and acid-base equilibrium. Though seemingly straightforward, the procedure of collecting arterial blood for ABG analysis carries inherent risks and complications, especially when performed by untrained individuals or under time constraints. Recognizing the prevalence of non-uniformity and errors in drawing arterial blood, this Quality Improvement Initiative was conducted. The primary objectives included setting standard goals with performing the Modified Allen Test being the most crucial for Radial Artery puncture, assessing quality, identifying deficits through observation and interviews, implementing educational interventions, and reassessing quality to enhance procedural accuracy. Methods: A Quality Improvement Study of arterial puncture was conducted with 22 participants (interns, postgraduate students, fellows) in a Tertiary Teaching Hospital's Emergency and Critical Care Units. After identifying the deficits, educational interventions were implemented and a reassessment was conducted. Results: The Modified Allen Test was not performed by any of the participants and only 40.9% of participants applied firm and immediate pressure at the puncture site with a gauze/cotton for 3-5 minutes. Post-intervention, a 100% result was achieved with all the participants performing the Modified Allen Test and applying firm, immediate pressure. Conclusion: There are discrepancies while collecting arterial blood for ABG analysis. An emphasis on formal training is required to address these knowledge and procedural shortfalls which if not taken care of may lead to serious complications that are detrimental to patient health. Key words: Quality Improvement Initiative, Modified Allen Test, Radial artery puncture, ABG analysis, Clinical Audit, Critical care