Cost analysis of strategies to reduce blood culture contamination in the emergency department: sterile collection kits and phlebotomy teams

Abstract

Objective: Blood culture collection practices that reduce contamination, such as sterile blood culture collection kits and phlebotomy teams, increase up-front costs for collecting cultures but may lead to net savings by eliminating downstream costs associated with contamination. The study objective was to compare overall hospital costs associated with 3 collection strategies: usual care, sterile kits, and phlebotomy teams.

Design: Cost analysis.

Setting: This analysis was conducted from the perspective of a hospital leadership team selecting a blood culture collection strategy for an adult emergency department (ED) with 8,000 cultures drawn annually.

Methods: Total hospital costs associated with 3 strategies were compared: (1) usual care, with nurses collecting cultures without a standardized protocol; (2) sterile kits, with nurses using a dedicated sterile collection kit; and (3) phlebotomy teams, with cultures collected by laboratory-based phlebotomists. In the base case, contamination rates associated with usual care, sterile kits, and phlebotomy teams were assumed to be 4.34%, 1.68%, and 1.10%, respectively. Total hospital costs included costs of collecting cultures and hospitalization costs according to culture results (negative, true positive, and contaminated).

Results: Compared with usual care, annual net savings using the sterile kit and phlebotomy team strategies were $483,219 and $288,980, respectively. Both strategies remained less costly than usual care across a broad range of sensitivity analyses.

Conclusions: EDs with high blood culture contamination rates should strongly consider evidence-based strategies to reduce contamination. In addition to improving quality, implementing a sterile collection kit or phlebotomy team strategy is likely to result in net cost savings.

Figure 1

Decision tree modeling the cost implications of collecting ED blood cultures by the usual care, sterile kit and phlebotomy team strategies.

Figure 2

One way sensitivity analyses, including (A) analysis with variation in the sterile kit strategy blood culture contamination rate, and (B) variation in the hospital charge for patients with a contaminated blood culture.

Figure 3

Two-way sensitivity analysis on the annual number of blood cultures collected in the emergency department and the annual cost to staff a phlebotomy team.* *Usual care did not result in the lowest costs at any point along the ranges evaluated in this analysis.