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. 2015 Apr;135(4):e1052-9.
doi: 10.1542/peds.2014-2077. Epub 2015 Mar 16.

Improvement methodology increases guideline recommended blood cultures in children with pneumonia

Eileen Murtagh Kurowski  1 , Samir S Shah  2 , Joanna Thomson  3 , Angela Statile  3 , Brieanne Sheehan  4 , Srikant Iyer  5 , Christine White  3 , Lilliam Ambroggio  3
Affiliations

Improvement methodology increases guideline recommended blood cultures in children with pneumonia

Eileen Murtagh Kurowski et al. Pediatrics. 2015 Apr.

Abstract

Background and objective: A national evidence-based guideline for the management of community-acquired pneumonia (CAP) in children recommends blood cultures for patients admitted with moderate to severe illness. Our primary aim was to increase ordering of blood cultures for children hospitalized with CAP from 53% to 90% in 6 months. The secondary aim was to evaluate the effect of obtaining blood cultures on length of stay (LOS).

Methods: At a tertiary children's hospital, interventions to increase blood cultures focused on 3 key drivers and were tested separately in the emergency department and inpatient units by using multiple plan-do-study-act cycles. The impact of the interventions was tracked over time on run charts. The association of ordering blood cultures and LOS was estimated by using linear regression models.

Results: Within 6 months, the percentage of patients admitted with CAP who had blood cultures ordered increased from 53% to 100%. This change has been sustained for 12 months. Overall, 239 (79%) of the 303 included patients had a blood culture ordered; of these, 6 (2.5%) were positive. Patients who had a blood culture did not have an increased LOS compared with those without a blood culture.

Conclusions: Quality improvement methods were used to increase adherence to evidence-based national guidelines for performing blood cultures on children hospitalized with CAP; LOS did not increase. These results support obtaining blood cultures on all patients admitted with CAP without negative effects on LOS in a setting with a reliably low false-positive blood culture rate.

Keywords: blood culture; pediatric; pneumonia.

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Conflict of interest statement

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

Figures

FIGURE 1. Process map for pneumonia patients admitted from the ED. BCX, blood culture; PNA, pneumonia.
FIGURE 1
Process map for pneumonia patients admitted from the ED. BCX, blood culture; PNA, pneumonia.
FIGURE 2. Key driver diagram summarizing the project aim and interventions implemented to achieve the stated aim.
FIGURE 2
Key driver diagram summarizing the project aim and interventions implemented to achieve the stated aim.
FIGURE 3. A, Run chart for overall proportion of admitted pneumonia patients with a blood culture performed within 24 hours of initial presentation. B, Run chart for proportion of admitted pneumonia patients with a blood culture performed in the ED. H&P, history and physical examination; ID, identify.
FIGURE 3
A, Run chart for overall proportion of admitted pneumonia patients with a blood culture performed within 24 hours of initial presentation. B, Run chart for proportion of admitted pneumonia patients with a blood culture performed in the ED. H&P, history and physical examination; ID, identify.
See this image and copyright information in PMC

Comment in

  • Improvement Without Value.
    Quinonez RA, Garber MD. Quinonez RA, et al. Pediatrics. 2015 Aug;136(2):e549. doi: 10.1542/peds.2015-1549A. Pediatrics. 2015. PMID: 26232445 No abstract available.
  • Author's Response.
    Murtagh Kurowski E, Shah SS, Thomson J, Statile A, Iyer S, White C, Ambroggio L. Murtagh Kurowski E, et al. Pediatrics. 2015 Aug;136(2):e549-50. doi: 10.1542/peds.2015-1549B. Pediatrics. 2015. PMID: 26232446 No abstract available.

References

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