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VOLUME 6 , ISSUE 1 ( January-June, 2018 ) > List of Articles

ORIGINAL ARTICLE

A Study on Utilization of Blood Culture Reports in the Emergency Department at a Tertiary Care Teaching Hospital in North India

Sujeet K Sinha, Ray Pallab, Madaan Nirupam

Keywords : Blood culture, Emergency department, Intervention, Utilization

Citation Information : Sinha SK, Pallab R, Nirupam M. A Study on Utilization of Blood Culture Reports in the Emergency Department at a Tertiary Care Teaching Hospital in North India. Int J Res Foundation Hosp Healthc Adm 2018; 6 (1):12-16.

DOI: 10.5005/jp-journals-10035-1085

License: CC BY-SA 4.0

Published Online: 01-02-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Introduction: It is invariably observed that blood cultures are more often ordered because the patient has fever or the admitting physician wants them for any expectation of clinical impact. As a result of such practice, unnecessary blood culture is being ordered with negative financial impact on hospital as well as the patients. The indication for obtaining blood cultures from patients in the Emergency Department (ED) is even less clear. This study was done to study the utilization of blood report in the emergency department of a tertiary care teaching hospital in north India. Need of the study: It was a common perception among the emergency medicine physician that they did not get blood culture reports on time from the Microbiology Department. The reports are either misplaced or received late as desired by the physician. A pilot study was done to check the hypothesis. Totally seventy blood culture samples were sent from the medical emergency ward and surgical emergency ward over a 3-week period. It was observed that 25% of total blood culture reports did not reach the physician. Aim and objective: (1) To study the utilization of blood culture report in emergency, (2) to design an intervention for timely availability of blood culture reports, and (3) to Study the impact of the intervention on the utilization of blood culture reports. Materials and methods: The study was cross-sectional, record-based prospective study, supplemented with interview of treating doctors. All patients admitted in the emergency ward (one each from medical and surgical) were followed up for 3 months. An Intervention was done personally by the researcher to ensure that all the test reports reach the patient file within 6 hours of its generation. Observation: Out of total 104 blood culture reports sent in preintervention, change in treatment according to culture report was done only in 7.6%. In postintervention, it increased to 9.9%. It was found that the clinician did not narrow down treatment even when the cultures are positive. About 77.1% of positive blood culture reports get wasted in preintervention and 54.5% in postintervention. Conclusion: There was ample loss of hospital resources in respect of money as well as manpower if even a single blood culture report is not utilized.


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  1. Beekman SE, Diekema DJ, Chapin KC, Doern GV. Effects of rapid detection of bloodstream infections on length of hospitalization and hospital charges. J Clin Microbiol 2003 Jul;41(7):3119-3125.
  2. Xu J, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths: final data for 2007. Natl Vital Stat Rep 2010 May;58(19):1-19.
  3. Wilson ML. Clinically relevant, cost-effective clinical microbiology. Strategies to decrease unnecessary testing. Am J Clin Pathol 1997 Feb;107(2):154-167.
  4. Zwang O, Albert RK. Analysis of strategies to improve cost effectiveness of blood cultures. J Hosp Med 2006 Sep;1(5):272-276.
  5. Bates DW, Goldman L, Lee TH. Contaminant blood cultures and resource utilization. The true consequences of falsepositive results. JAMA 1991 Jan;265(3):365-369.
  6. Trenholme GM, Kaplan RL, Karakusis PH, Stine T, Fuhrer J, Landau W, Levin S. Clinical impact of rapid identification and susceptibility testing of bacterial blood culture isolates. J Clin Microbiol 1989 Jun;27(6):1342-1345.
  7. Endimiani A, Tamborini A, Luzzaro F, Lombardi G, Toniolo A. A two-year analysis of risk factors and outcome in patients with bloodstream infection. J Infect Dis 2003 Feb;56(1):1-7.
  8. Grace CJ, Lieberman J, Pierce K, Littenberg B. Usefulness of blood culture for hospitalized patients who are receiving antibiotic therapy. Clin Infect Dis 2001 Jun;32(11):1651-1655.
  9. Murty DS, Gyaneshwari M. Blood cultures in paediatric patients: a study of clinical impact. Indian J Med Microbiol 2007 Jul-Sep;25(3):220-224.
  10. Birnbaumer DM. Blood cultures aren't useful for managing immune competent CAP inpatients. JWEM 2004.
  11. Campbell SG, Marrie TJ, Anstey R, Dickinson G, Ackroyd- Stolarz S. The contribution of blood cultures to the clinical management of adult patients admitted to the hospital with community-acquired pneumonia: a prospective observational study. Chest 2003 Apr;123(4):1142-1150.
  12. Waterer GW, Jennings SG, Wunderink RG. The impact of blood cultures on antibiotic therapy in pneumococcal pneumonia. Chest 1999 Nov;116(5):1278-1281.
  13. Chalasani NP, Valdecanas MA, Gopal AK, McGowan JE Jr, Jurado RL. Clinical utility of blood cultures in adult patients with community-acquired pneumonia without defined underlying risks. Chest 1995 Oct;108(4):932-936.
  14. Corbo J, Friedman B, Bijur P, Gallagher EJ. Limited usefulness of initial blood cultures in community acquired pneumonia. Emerg Med J 2004 Jul;21(4):446-448.
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