WIP 16 - Unnecessary Blood Cultures Drawn in a Quaternary Care Children’s Hospital Emergency Department: A Quality Improvement Project

Publication Number: WIP 16.7640

Leah Schornick, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Samina Bhumbra, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Jack G.. Schneider, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Jessica Kanis, IU Health - - Indianapolis, IN, Indianapolis ,IN, USA, IN, United States; Richelle Baker, Indiana University School of Medicine, Indianapolis, IN, United States

Background: Obtaining unnecessary blood cultures in the ED has potential for deleterious downstream effects, including increased contamination rates, increased length of stay, increased exposure and duration of IV antibiotics and overall increased cost to both patients and hospital. The 2024 national blood culture bottle shortage starting in summer 2024 has resulted in efforts to reduce the number of unnecessary blood cultures. The primary objective is to reduce the number of unnecessary blood cultures obtained in the Riley ED through education of staff using internal practice guidelines and leveraging EMR to influence ordering practices.

Objective: The primary aim of this project is to reduce the total number of blood cultures bottles used in the Riley Hospital for Children Emergency Department by 30% in a 6-month period (September 2024-March 2025).

Design/Methods: This QI project is following a Plan-Do-Study-Act method to educate ED providers about evidence-based criteria for obtaining blood cultures on previously healthy children. This study was determined to be IRB exempt in November 2022. Nurses working in the emergency department were surveyed to ascertain their current blood culture drawing practices to direct nursing education. Intervention 1 (Aug 2024) added guidance to the blood culture order set in our EMR, providing clinical decision support for physicians on when to obtain blood cultures. For intervention 2 (Sept 2024), education flyers were strategically placed throughout the ED with information geared towards either the nurses or providers. Impact of the intervention will be determined by tracking the blood culture bottles stocked in the Riley ED, the number of blood cultures sent to the lab from the Riley ED, and the number of patients seen in the Riley ED monthly and compared to utilization practices during the 6 months preceding these interventions. Monthly data assessment and PDSA cycles will be completed to determine the need for additional interventions. Data collection will end in March of 2025 with all data analysis being completed by April of 2025.