Culture Pus, Not Blood: Decreasing Routine Laboratory Testing in Patients With Uncomplicated Skin and Soft Tissue...

Blood cultures and complete blood cell counts (CBCs) are commonly used in evaluating patients with skin and soft tissue infections (SSTIs). Published data have shown that these tests may not aid in patient management. The objective of this study was to decrease the collection of blood test specimens in children with uncomplicated SSTIs.

We designed a longitudinal preintervention/postintervention study that used modifications of well-known propaganda posters. These were displayed in work stations to discourage staff from ordering routine blood cultures in children being evaluated for uncomplicated SSTIs. We studied a total of 230 otherwise healthy patients with SSTIs admitted to a freestanding children's hospital between September 1, 2013, and August 31, 2014. Data were collected in 3 groups: a 4-month baseline period, a 4-month poster display period, and a 4-month follow-up period to determine practice change persistence. Data collected included baseline clinical characteristics, the number of laboratory studies obtained, and outcomes (including length of stay).

Patients in the 3 groups were similar in terms of clinical characteristics. Compared with baseline, posters were associated with decreased blood cultures (47%-17%; P < .001) and CBCs (53%-36%; P = .04). This effect partially persisted for results of blood cultures (27%; P = .01) and CBCs (42%, P = .17). There was no change in median length of stay. Seven-day emergency department returns increased in the poster group (0-7%; P = .02) with no clear relation to laboratory testing, but not in the follow-up group (3%; P = .15).

A simple and creative poster campaign improved staff laboratory testing practices.