A quality improvement project to reduce follow-up blood culture utilization through diagnostic stewardship
Jeffrey M. Kubiak, Barbara Ross, Xiao Qing Wang, Regina Wulff, David Kuang, Anne Norris, Trevona Gonsalves, Stacia Semple, Jamie Marino, Karen P. Acker, Harold Horowitz, Tina Wang, Daniel A. Green, Gregory J. Berry, Elizabeth F. Stone, Dakai Liu, Cheryl Goss, Nishant Prasad, Robert Kim, Matthew Simon, Lars Westblade, E. Yoko Furuya, Harjot K. SinghAbstract
Objective:
To reduce the use of follow-up blood cultures (FUBC), that is repeat blood cultures (BCs) used to monitor patients for clearance of a prior positive BC, or with new/worsening symptoms after negative BCs, by 10%.
Design:
Multicenter quality improvement study.
Setting:
A network of 8 hospitals, including academic tertiary care centers and community hospitals.
Participants:
40,021 patients, including adult, pediatric, inpatients, and outpatients, for whom blood cultures were ordered over a 24-week period in 2024.
Interventions:
We implemented a series of iterative Plan-Do-Study-Act (PDSA) cycles to guide clinicians toward appropriate BC ordering. These cycles included educational memos, limiting the ability to order more than one BC at a time, a best practice advisory in the electronic health record to limit BC orders with a prior negative within 72 hours, and a new order panel for BCs that defaulted FUBC to a single set.
Results:
Prior to the intervention period, FUBCs comprised 29% of all BC orders placed. After the intervention, there was an 18% absolute reduction in FUBC, primarily due to decreased use of paired FUBC sets. There were no increases in the length of stay, in-hospital mortality, or 30-day readmission.
Conclusions:
We exceeded our goal to decrease FUBCs using diagnostic stewardship. This approach to FUBCs is sustainable and scalable as part of diagnostic stewardship strategies for BC stewardship.