Dissemination of a Novel Framework to Improve Blood Culture Use in Pediatric Critical Care

Charlotte Z Woods-Hill^{1

2}, Laura Lee³, Anping Xie^{4

5}, Anne F King⁶, Annie Voskertchian⁶, Sybil A Klaus^{7

8}, Michelle M Smith⁹, Marlene R Miller^{5

10

11}, Elizabeth A Colantuoni¹², James C Fackler⁴, Aaron M Milstone⁶

Affiliations

¹ The Children's Hospital of Philadelphia, Philadelphia, Pa.
² The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pa.
³ Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va.
⁴ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
⁵ Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Md.
⁶ Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
⁷ MITRE Corporation, Mclean, Va.
⁸ Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
⁹ The Johns Hopkins All Children's Hospital, St Petersburg, Fla.
¹⁰ Division of Quality and Safety, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
¹¹ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
¹² Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.

PMID: 30584639
PMCID: PMC6221585
DOI: 10.1097/pq9.0000000000000112

Dissemination of a Novel Framework to Improve Blood Culture Use in Pediatric Critical Care

Charlotte Z Woods-Hill et al. Pediatr Qual Saf. 2018.

. 2018 Oct 16;3(5):e112.

doi: 10.1097/pq9.0000000000000112. eCollection 2018 Sep-Oct.

Authors

Affiliations

¹ The Children's Hospital of Philadelphia, Philadelphia, Pa.
² The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pa.
³ Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va.
⁴ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
⁵ Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Md.
⁶ Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
⁷ MITRE Corporation, Mclean, Va.
⁸ Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
⁹ The Johns Hopkins All Children's Hospital, St Petersburg, Fla.
¹⁰ Division of Quality and Safety, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
¹¹ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
¹² Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.

PMID: 30584639
PMCID: PMC6221585
DOI: 10.1097/pq9.0000000000000112

Abstract

Introduction: Single center work demonstrated a safe reduction in unnecessary blood culture use in critically ill children. Our objective was to develop and implement a customizable quality improvement framework to reduce unnecessary blood culture testing in critically ill children across diverse clinical settings and various institutions.

Methods: Three pediatric intensive care units (14 bed medical/cardiac; 28 bed medical; 22 bed cardiac) in 2 institutions adapted and implemented a 5-part Blood Culture Improvement Framework, supported by a coordinating multidisciplinary team. Blood culture rates were compared for 24 months preimplementation to 24 months postimplementation.

Results: Blood culture rates decreased from 13.3, 13.5, and 11.5 cultures per 100 patient-days preimplementation to 6.4, 9.1, and 8.3 cultures per 100 patient-days postimplementation for Unit A, B, and C, respectively; a decrease of 32% (95% confidence interval, 25-43%; P < 0.001) for the 3 units combined. Postimplementation, the proportion of total blood cultures drawn from central venous catheters decreased by 51% for the 3 units combined (95% confidence interval, 29-66%; P < 0.001). Notable difference between units included the identity and involvement of the project champion, adaptions of the clinical tools, and staff monitoring and communication of project progress. Qualitative data also revealed a core set of barriers and facilitators to behavior change around pediatric intensive care unit blood culture practices.

Conclusions: Three pediatric intensive units adapted a novel 5-part improvement framework and successfully reduced blood culture use in critically ill children, demonstrating that different providers and practice environments can adapt diagnostic stewardship programs.

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Figures

**Fig. 1.**
Rate of blood cultures in units A, B, and C before vs. after implementation of a quality improvement initiative to optimize use of blood cultures. Postintervention time period began January 2016.

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Dissemination of a Novel Framework to Improve Blood Culture Use in Pediatric Critical Care

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Dissemination of a Novel Framework to Improve Blood Culture Use in Pediatric Critical Care

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