A comparison of blood culture diagnostic stewardship across three emergency departments in a healthcare network.

BACKGROUND

Blood culture (BCx) diagnostic stewardship is essential for reducing unnecessary treatments, minimizing false-positive results, and improving patient outcomes and hospital resource utilization. The objective of this study was to compare the effectiveness of diagnostic stewardship interventions on BCx utilization in three emergency departments (ED).

METHODS

We used a quasi-experimental pre-/post-intervention study to compare BCx rates (BCx/100 ED visits) between December 1, 2020, and February 29, 2024 before and after the implementation of a BCx algorithm and electronic health record (EHR) modifications at one large academic ED and level 1 trauma center, and two EDs at academic-affiliated community hospitals. A sample of visits with a BCx order were audited in one academic ED and one academic-affiliated ED, and summary data on indication appropriateness were provided to respective leadership. In the academic ED, there was weekly provider led audit and feedback on 3478 ED visits. In one academic-affiliated ED, one pharmacist reviewed five visits weekly (100 total) for appropriateness. The second academic-affiliated ED served as a control and did not receive any feedback on BCx utilization. Each ED's BCx rates were analyzed using interrupted time series models. Incidence rate ratios (IRR) compared BCx rates before and after the interventions.

RESULTS

A total of 211,950 BCxs over 572,776 ED visits were included in the analysis. The academic ED saw a 25 % decrease in BCx rate with IRR 0.80 (95 % CI 0.74, 0.86, p-value 0.01). The first academic-affiliated ED experienced a 0.8 % decrease in BCx rate with IRR 1.1 (95 % CI 1.01, 1.19, p-value 0.02). No change was observed in the second academic-affiliated ED.

CONCLUSIONS

Decreased BCx rates occurred only after direct audit and feedback and EHR modifications. Both the academic ED and first academic-affiliated ED saw a drift back towards pre-intervention BCx rates after the intervention.