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Quality Improvement Project Reducing Sputum Cultures for Pediatric Patients With a Tracheostomy
Baila Harris1,2, Kristina Kern1, Christopher Benner1,2
1Department of Pediatrics, Helen DeVos Children's Hospital, Grand Rapids, Michigan.
Insights
A quality improvement project successfully reduced sputum cultures in children with tracheostomies by implementing a new algorithm. This initiative decreased culture rates significantly without impacting patient length of stay or emergency department return visits.
Area of Science:
- Pediatric Medicine
- Quality Improvement Science
- Infectious Disease Diagnostics
Background:
- Overuse of diagnostic testing and overtreatment are concerns in pediatric tracheostomy care.
- Sputum cultures are frequently obtained in children with tracheostomies without clear guidelines or proven impact on management.
- Current practice suggests a need to optimize diagnostic strategies for this vulnerable population.
Purpose of the Study:
- To decrease the rate of sputum cultures in pediatric patients with tracheostomies by 50%.
- To implement and evaluate a quality improvement project aimed at reducing unnecessary diagnostic testing.
- To establish standardized decision-making for sputum culture collection in this patient group.
Main Methods:
- A single-center quality improvement project was conducted in a pediatric emergency department.
- An algorithm for sputum culture collection was developed and implemented, supported by electronic medical record modifications and education.
- Data on culture rates, length of stay, and emergency department return visits were collected pre- and post-intervention.
Main Results:
- The rate of sputum cultures decreased from 64% to 25%, exceeding the 50% reduction target.
- No significant changes were observed in patient length of stay or the rate of return emergency department visits.
- Statistical process control charts indicated a significant, nonrandom shift in culture rates post-intervention.
Conclusions:
- An algorithm effectively reduced the number of sputum cultures obtained in children with tracheostomies.
- The implemented changes demonstrate the feasibility of optimizing diagnostic testing protocols.
- Further research is warranted to assess the safety and efficacy of this algorithm in a broader patient population.
Background And Objectives:
Current research implies overuse of diagnostic testing and overtreatment in children with tracheostomies. There are no guidelines for obtaining sputum cultures for these patients, yet they are commonly obtained without significantly affecting management or outcomes. The aim of our quality improvement project was to decrease rate of sputum cultures in this population by 50%, from 64% to 32%.
Methods:
This was a single-center quality improvement project conducted in a pediatric emergency department (ED). Key drivers included: Standardized decision-making, appropriate culture collection, knowledge regarding colonization versus clinically relevant growth, and viral versus bacterial infections in this population. The study team developed an algorithm, used modification to electronic medical records orders, and provided education to drive change. Six months of preintervention and 12 months postintervention data were collected. Run charts/statistical process charts were created for the rate of cultures, length of stay, and return to the ED.
Results:
There were 159 patient encounters and the rate of sputum cultures decreased from 64% at baseline to 25% without change in length of stay or increased rate at which patients returned to the ED, including during local coronavirus disease 2019 and respiratory syncytial virus surges. We observed nonrandom data patterns after introduction of algorithm resulting in centerline shifts.
Conclusions:
The study team was able to introduce an algorithm coinciding with a reduction in number of sputum cultures obtained. Next steps would be determining safety and efficacy of such an algorithm over a larger population.
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