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Preparation of a Blood Culture Pellet for Rapid Bacterial Identification and Antibiotic Susceptibility Testing
Published on: October 15, 2014
Improvement methodology increases guideline recommended blood cultures in children with pneumonia
Eileen Murtagh Kurowski1, Samir S Shah2, Joanna Thomson3
1Divisions of Emergency Medicine, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and eileen.murtagh-kurowski@cchmc.org.
Insights
Implementing quality improvement strategies successfully increased blood cultures for pediatric community-acquired pneumonia (CAP) patients, with no impact on length of stay (LOS). This supports guideline adherence for hospitalized children with CAP.
Area of Science:
- Pediatric Infectious Diseases
- Healthcare Quality Improvement
- Clinical Guideline Adherence
Background:
- National guidelines recommend blood cultures for moderate to severe pediatric community-acquired pneumonia (CAP).
- Baseline ordering of blood cultures for hospitalized CAP patients was suboptimal at 53%.
Purpose of the Study:
- To increase blood culture ordering for pediatric CAP admissions from 53% to 90% within six months.
- To assess the impact of increased blood culture utilization on patient length of stay (LOS).
Main Methods:
- Quality improvement interventions utilizing plan-do-study-act cycles were implemented in emergency and inpatient units.
- Data on blood culture ordering and LOS were tracked using run charts and analyzed with linear regression.
Main Results:
- Blood culture ordering for pediatric CAP admissions rapidly increased from 53% to 100% within six months and was sustained.
- Of 303 patients, 79% had blood cultures drawn, with a 2.5% positive rate.
- No significant increase in length of stay was observed for patients who underwent blood culturing.
Conclusions:
- Quality improvement initiatives effectively enhanced adherence to evidence-based guidelines for pediatric CAP blood cultures.
- Obtaining blood cultures for all pediatric CAP admissions did not negatively affect length of stay.
- These findings support routine blood culturing in pediatric CAP cases with a low false-positive rate.
Background And Objective:
A national evidence-based guideline for the management of community-acquired pneumonia (CAP) in children recommends blood cultures for patients admitted with moderate to severe illness. Our primary aim was to increase ordering of blood cultures for children hospitalized with CAP from 53% to 90% in 6 months. The secondary aim was to evaluate the effect of obtaining blood cultures on length of stay (LOS).
Methods:
At a tertiary children's hospital, interventions to increase blood cultures focused on 3 key drivers and were tested separately in the emergency department and inpatient units by using multiple plan-do-study-act cycles. The impact of the interventions was tracked over time on run charts. The association of ordering blood cultures and LOS was estimated by using linear regression models.
Results:
Within 6 months, the percentage of patients admitted with CAP who had blood cultures ordered increased from 53% to 100%. This change has been sustained for 12 months. Overall, 239 (79%) of the 303 included patients had a blood culture ordered; of these, 6 (2.5%) were positive. Patients who had a blood culture did not have an increased LOS compared with those without a blood culture.
Conclusions:
Quality improvement methods were used to increase adherence to evidence-based national guidelines for performing blood cultures on children hospitalized with CAP; LOS did not increase. These results support obtaining blood cultures on all patients admitted with CAP without negative effects on LOS in a setting with a reliably low false-positive blood culture rate.
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