8 Simple Interventions Positively Affect Emergency Physician Blood Culture Orders

Primary Objective: To determine if evidence-based blood culture ordering guidelines reduce the total number of blood cultures generated in the emergency department (ED) without negatively affecting patient care. Secondary Objectives: Does the intervention affect hospital length of stay (LOS) and laboratory quality measures, such as contaminated blood cultures? What is the sensitivity of the blood culture ordering guidelines? This is a prospective observational study performed at a health system that comprises a tertiary care level 1 trauma center with a large residency program, an urban hospital and rural freestanding emergency department. Inclusion criteria consist of all patients age 18 and older for whom blood cultures were obtained in the emergency department and analyzed in the lab. Prior to the introduction of ED blood culture ordering guidelines in August 2014, a review of patients who had blood cultures obtained in the ED were analyzed for demographics, blood culture results, length of ED stay, ED disposition, and vital signs. The ED blood culture ordering guidelines were then implemented into the ED computerized physician-ordering entry, and staff was educated regarding the guidelines. After introduction of the guidelines, a review of patients who had blood cultures ordered in the ED was again performed. The primary outcome was the change in the number of blood cultures ordered in the emergency department before and after implementation of the blood culture ordering guidelines. Secondary outcomes included the change in number of contaminated blood cultures, the sensitivity of the blood culture ordering guidelines and the difference in hospital length of stay and ED disposition. Prior to blood culture ordering guideline implementation, an average of 1,668 blood cultures were obtained monthly at our institution. Following implementation, as of March 2015, we decreased ED generated blood cultures to an average of 1,190, which is a 43% reduction. Blood culture contamination rates remained unchanged during the intervention. Analysis of secondary outcomes is ongoing. We developed simple and effective ED blood culture ordering guidelines that reduce unnecessary blood culture ordering in the ED without negatively affecting contamination rate of blood cultures. Analysis of secondary outcomes will delineate effects on hospital length of stay and determine if ED providers failed to order blood cultures when indicated.