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Use and abuse of blood cultures: program to limit use
P A Gross1, C L Van Antwerpen, W A Hess
1Department of Internal Medicine, Hackensack Medical Center, NJ 07601.
Abstract:
Many health care providers order an unnecessary number of blood cultures. We studied the ordering habits in our medical intensive care unit and recommended a protocol for appropriate ordering. Implementation of the protocol resulted in a significant reduction in the number of episodes of suspected sepsis, from 39% of patient discharges during the baseline period to 16% during the study period (p = 0.008). The mean number of blood cultures decreased significantly from 1.2 per patient discharge to 0.3 (p = 0.003). The number of episodes when more than four blood cultures were ordered decreased from 7 to 0, resulting in an annual cost savings estimated at $8025. The net benefit was reversed, however, when the protocol ceased to be actively implemented. We concluded that the appropriate ordering of blood cultures can be effected by establishing a protocol that is actively and continuously implemented.
Insights
Implementing a blood culture ordering protocol significantly reduced unnecessary tests and costs in an intensive care unit. Continuous implementation is key to maintaining these benefits.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Healthcare Management
Background:
- Overutilization of blood cultures is a common issue in healthcare settings.
- This practice contributes to increased healthcare costs and potential patient harm.
- Optimizing diagnostic test ordering is crucial for efficient patient care.
Purpose of the Study:
- To evaluate the impact of a standardized protocol on blood culture ordering practices.
- To assess the effectiveness of the protocol in reducing unnecessary blood cultures.
- To determine the cost-effectiveness of implementing an appropriate blood culture ordering protocol.
Main Methods:
- A protocol for appropriate blood culture ordering was developed and implemented in a medical intensive care unit.
- Ordering habits were monitored during a baseline period and a study period.
- Key metrics included the percentage of patient discharges with suspected sepsis and the mean number of blood cultures per discharge.
Main Results:
- Implementation of the protocol led to a significant reduction in suspected sepsis episodes from 39% to 16% (p = 0.008).
- The mean number of blood cultures per patient discharge decreased significantly from 1.2 to 0.3 (p = 0.003).
- Episodes with more than four blood cultures ordered dropped from 7 to 0, yielding an estimated annual cost saving of $8025.
Conclusions:
- A continuously and actively implemented protocol can effectively reduce unnecessary blood cultures.
- The benefits of the protocol were diminished when active implementation ceased, highlighting the need for ongoing adherence.
- Standardized protocols are essential for optimizing diagnostic testing and managing healthcare resources effectively.