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[Blood culture utilization and its indications in emergency departments; time for change?]
Daniëlle Kroon1,2, Judith van Kreij1, David Baden3
1Radboudumc, afd. IQ Health, Nijmegen.
Insights
Blood culture (BC) collection rates and criteria vary significantly across emergency departments (EDs). Standardizing indications and cutoff values is crucial for appropriate BC utilization and patient care.
Area of Science:
- Clinical Microbiology
- Emergency Medicine
- Healthcare Quality Improvement
Context:
- Blood cultures (BC) are vital for diagnosing bloodstream infections in emergency departments (EDs).
- Current practices for BC collection in EDs lack standardization.
- Variations in BC utilization can impact patient care and resource allocation.
Purpose:
- To investigate the utilization patterns of blood cultures in emergency departments.
- To identify and analyze the differences in indications and cutoff values for BC collection across multiple EDs.
- To highlight the need for standardized criteria in BC collection.
Summary:
- A retrospective study analyzed BC collection data from 11 EDs between 2018-2020.
- Significant variation was observed in the percentage of patients receiving BCs (19%-30%) and in the specific indications and temperature cutoff values used for collection.
- Fever and hypothermia criteria showed notable differences in thresholds across participating EDs.
Impact:
- Highlights substantial variability in BC collection practices within EDs.
- Underscores the need for a national dialogue to establish uniform criteria for BC utilization.
- Suggests structured benchmarking as a method to promote more appropriate BC collection and improve diagnostic accuracy.
Objective:
To gain insight into the blood culture (BC) utilization in emergency departments (EDs) and to identify differences in the indications for BC collection.
Design:
Retrospective study METHOD: Data were collected in 11 EDs for 2018, 2019, and 2020. Indications for blood culture collection were identified in from the hospital protocols. Participants indicated which indications are used in their ED.
Results:
In 2019, ten EDs collected BC from 19% to 30% of all patients for internal medicine and geriatrics. Both the used indications and the cutoff values varied. For fever, >38.0°C, >38.3°C, or >38.5°C were used, and for hypothermia <36.0°C or <35.0°C.
Conclusion:
There is a variation in the percentage of collected BC in the EDs. Additionally, the used indications and the cutoff values differed. A national discussion on criteria is needed to reduce this variation. Meanwhile, structured benchmarking can make BC collection more appropriate.
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