期刊名称：General Internal Medicine and Clinical Innovations
电子版ISSN：2397-5237
出版年度：2016
卷号：1
期号：2
页码：20-25
DOI：10.15761-GIMCI.1000107
语种：English
出版社：Open Access Text
摘要：ObjectivesBlood cultures are an essential tool in the accurate diagnosis of bacteremia, but are often overused in low- risk patients. The inappropriate ordering of blood cultures risks exposing patients to prolonged unnecessary courses of antibiotics and increases treatment costs. In our Adult Emergency Department (AED), an evidence-based algorithm was developed to guide blood culture ordering based on a validated clinical decision rule (Shapiro Rule). The primary goal of this study was to assess the effects of this algorithm on rate of blood culture collection in the AED.MethodsThis study is a retrospective observational study pre and post intervention. Laboratory data were used to track rates of blood culture ordering and contamination before and after the implementation of the blood culture ordering algorithm. A clinical decision support tool was also implemented into our electronic medical record (EMR) to remind providers of the ordering criteria and to track the reasons for which blood cultures were being performed. These responses were extracted from the EMR and analyzed using descriptive statistics.ResultsAfter implementation of the algorithm, we observed a 33.5% decrease in the mean monthly blood cultures ordered from the AED. This result was statistically significant with a p-value of ConclusionsThis study demonstrates that evidence-based institutional protocols can be implemented quickly and be efficacious in preventing unnecessary blood culture testing, thereby reducing costs of care. The utilization of an interdisciplinary approach and effective incorporation of information technology are key components in ensuring initial success and sustainability over time.
