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

Autor:	Woods-Hill CZ; The Children's Hospital of Philadelphia, Philadelphia, Pa.; The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pa., Lee L; Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va., Xie A; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.; Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Md., King AF; Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md., Voskertchian A; Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md., Klaus SA; MITRE Corporation, Mclean, Va.; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md., Smith MM; The Johns Hopkins All Children's Hospital, St Petersburg, Fla., Miller MR; Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Md.; Division of Quality and Safety, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md., Colantuoni EA; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md., Fackler JC; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md., Milstone AM; Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
Jazyk:	angličtina
Zdroj:	Pediatric quality & safety [Pediatr Qual Saf] 2018 Oct 16; Vol. 3 (5), pp. e112. Date of Electronic Publication: 2018 Oct 16 (Print Publication: 2018).
DOI:	10.1097/pq9.0000000000000112
Abstrakt:	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.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu