Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department
- PMID: 35877074
- PMCID: PMC9471721
- DOI: 10.1093/jamia/ocac115
Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department
Abstract
Objective: Surviving Sepsis guidelines recommend blood cultures before administration of intravenous (IV) antibiotics for patients with sepsis or moderate to high risk of bacteremia. Clinical decision support (CDS) that reminds emergency department (ED) providers to obtain blood cultures when ordering IV antibiotics may lead to improvements in this process measure.
Methods: This was a multicenter causal impact analysis comparing timely blood culture collections prior to IV antibiotics for adult ED patients 1 year before and after a CDS intervention implementation in the electronic health record. A Bayesian structured time-series model compared daily timely blood cultures collected compared to a forecasted synthetic control. Mixed effects models evaluated the impact of the intervention controlling for confounders.
Results: The analysis included 54 538 patients over 2 years. In the baseline phase, 46.1% had blood cultures prior to IV antibiotics, compared to 58.8% after the intervention. Causal impact analysis determined an absolute increase of 13.1% (95% CI 10.4-15.7%) of timely blood culture collections overall, although the difference in patients with a sepsis diagnosis or who met CDC Adult Sepsis Event criteria was not significant, absolute difference 8.0% (95% CI -0.2 to 15.8). Blood culture positivity increased in the intervention phase, and contamination rates were similar in both study phases.
Discussion: CDS improved blood culture collection before IV antibiotics in the ED, without increasing overutilization.
Conclusion: A simple CDS alert increased timely blood culture collections in ED patients for whom concern for infection was high enough to warrant IV antibiotics.
Keywords: antibiotic stewardship; clinical decision support; emergency medicine; sepsis.
© The Author(s) 2022. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.
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References
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- Evans L, Rhodes A, Alhazzani W, et al.Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med 2021; 49 (11): e1063–143. - PubMed
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- Scheer CS, Fuchs C, Gründling M, et al.Impact of antibiotic administration on blood culture positivity at the beginning of sepsis: a prospective clinical cohort study. Clin Microbiol Infect 2019; 25 (3): 326–31. - PubMed
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- Cheng MP, Stenstrom R, Paquette K, for the FABLED Investigators, et al.Blood culture results before and after antimicrobial administration in patients with severe manifestations of sepsis: a diagnostic study. Ann Intern Med 2019; 171 (8): 547. - PubMed
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