Royal Brisbane and Women's Hospital (RBWH) has a high demand for acute and critical care services, with over a million life-saving treatments administered annually. This study focuses on improving decision-making regarding the use of arterial catheter – an invasive method in which a thin hollow tube is placed into an artery (blood vessel) to measure blood pressure in acute and critical care services.

Arterial catheter is highly used in the demanding landscape of acute and critical care at RBWH, where a substantial number of life-saving treatments are performed annually. This encompasses ~30,000 surgeries in the operating theatre (OT), 2,500 admissions to intensive care (ICU), and 400,000 emergency department (ED) presentations.

The vast majority (90%) of critically ill patients (in OT, ICU and ED) frequently require specific catheters inserted into arteries for continuous cardiac monitoring (e.g. blood pressure) and blood sampling. Unfortunately, these devices are associated with risks such as localised clotting, infection, and anaemia.

Using an innovative and systematic method to guide evidence review and collaboration with clinicians and consumers, the team will establish clear criteria for appropriate arterial catheter use versus non-invasive monitoring.

The team, led by Professor Samantha Keogh, gathered information from clinical trials, practice guidelines and common real-world situations to compile a list of 118 unique clinical scenarios, involving arterial catheter. A multi-disciplinary panel of ICU experts rated each scenario over two rounds.

Each scenario was assessed for how appropriate it would be to use an arterial catheter, considering the risks and benefits for the patient. The panel rated 66 scenarios as appropriate, 36 as inappropriate, and 16 as uncertain.

Arterial catheters were most often considered appropriate for patients needing strong support for their heart or lungs, such as those on medications to raise blood pressure or connected to advanced life-support machines. In contrast, patients who were stable and not needing major support were unlikely to benefit.

The outcome of this work is a practical decision-making guide that can help ICU teams reduce unnecessary procedures, avoid complications and provide more consistent, high-quality care. By helping clinicians decide when these catheters are truly needed, this project supports safer care for patients and contributes to national goals of reducing low-value or potentially harmful interventions in hospitals.