Dissemination of a Novel Framework to Improve Blood Culture Use in Pediatric Critical Care
Charlotte Z Woods-Hill1,2, Laura Lee3, Anping Xie4,5
1The Children's Hospital of Philadelphia, Philadelphia, Pa.
Insights
A quality improvement framework successfully reduced unnecessary blood culture use in pediatric intensive care units. This initiative demonstrated significant decreases in blood culture rates and central venous catheter draws, highlighting adaptable diagnostic stewardship.
Area of Science:
- Pediatric Critical Care Medicine
- Quality Improvement Science
- Diagnostic Stewardship
Background:
- Previous single-center studies showed safe reductions in blood culture use among critically ill children.
- The need for a customizable framework to implement these reductions across diverse institutions was identified.
Purpose of the Study:
- To develop and implement a customizable quality improvement framework.
- To reduce unnecessary blood culture testing in critically ill children in various clinical settings and institutions.
Main Methods:
- Three pediatric intensive care units (PICUs) across two institutions adapted and implemented a 5-part Blood Culture Improvement Framework.
- A coordinating multidisciplinary team supported the implementation.
- Blood culture rates were compared for 24 months pre- and post-implementation.
Main Results:
- Combined blood culture rates decreased by 32% (P < 0.001) across the three units.
- Post-implementation, blood cultures drawn from central venous catheters decreased by 51% (P < 0.001).
- Variations in project champion involvement, tool adaptation, and communication strategies were noted between units.
Conclusions:
- A novel 5-part improvement framework was successfully adapted and implemented in three PICUs.
- The framework led to a significant reduction in blood culture use among critically ill children.
- This demonstrates the adaptability of diagnostic stewardship programs across different providers and practice environments.
Introduction:
Single center work demonstrated a safe reduction in unnecessary blood culture use in critically ill children. Our objective was to develop and implement a customizable quality improvement framework to reduce unnecessary blood culture testing in critically ill children across diverse clinical settings and various institutions.
Methods:
Three pediatric intensive care units (14 bed medical/cardiac; 28 bed medical; 22 bed cardiac) in 2 institutions adapted and implemented a 5-part Blood Culture Improvement Framework, supported by a coordinating multidisciplinary team. Blood culture rates were compared for 24 months preimplementation to 24 months postimplementation.
Results:
Blood culture rates decreased from 13.3, 13.5, and 11.5 cultures per 100 patient-days preimplementation to 6.4, 9.1, and 8.3 cultures per 100 patient-days postimplementation for Unit A, B, and C, respectively; a decrease of 32% (95% confidence interval, 25-43%; P < 0.001) for the 3 units combined. Postimplementation, the proportion of total blood cultures drawn from central venous catheters decreased by 51% for the 3 units combined (95% confidence interval, 29-66%; P < 0.001). Notable difference between units included the identity and involvement of the project champion, adaptions of the clinical tools, and staff monitoring and communication of project progress. Qualitative data also revealed a core set of barriers and facilitators to behavior change around pediatric intensive care unit blood culture practices.
Conclusions:
Three pediatric intensive units adapted a novel 5-part improvement framework and successfully reduced blood culture use in critically ill children, demonstrating that different providers and practice environments can adapt diagnostic stewardship programs.
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