Cost analysis of blood cultures
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Cost analysis of blood cultures
Richard HuynhMarch 2013
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Introduction
• 4-7% of blood cultures are positive.• False positives -> 50% increase in cost, 64%
increase in length of stay. • Average of $70-100 per culture• Goal is to identify indications for blood
cultures• Cross sectional study of all patients currently
on medicine team D to assess if orders were appropriate vs inappropriate
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Indication
• 1 Major criteria included temperature > 39.5°C, indwelling vascular catheter, or clinical suspicion of endocarditis.
• 2 Minor criteria included temperature 38.3-39.4°C, age > 65 years, chills, vomiting, systolic blood pressure < 90 mm Hg, neutrophil% > 80, white blood cell count > 18, bands > 5%, platelets < 150, and creatinine > 2.0.
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Results Admitting Dx Culture Criteria
AKI Negative age>65 and Cr>2
Hypoglycemia HD 2 Negative 38.3, age>65 and Cr>2
UTI Negative WBC>18, chills
N/V, Liver abscess Negative 38.9, chills, vomiting
Weakness, HD 2 Negative 38.6, age>65
Obstructive jaundice
Negative Cr>2, vomiting
Chest pain Not ordered Cr>2
DM foot ulcer Negative None
AMS Negative age >65
Fatigue Negative WBC>18
SOB Negative WBC>18
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• Of 11 patients:– 55% (6) met criteria– 36% (4) did not meet criteria– 9% (1) appropriately not ordered
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Conclusions
• 4/11 did not meet criteria• Only 1/5 properly not ordered• Practice preventative medicine• Fever=culture• Confounding key factors• Physician dependent, ED vs IM• Sample size• Criteria may not be practical: wait until WBC>18?
Subjective chills and vomiting?
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Resources
Coburn B, Morris AM, Tomlinson G, Detsky AS. Does this adult patient with suspected bacteremia require blood cultures? JAMA. 2012 Aug;308(5):502-11.
Shapiro NI, Wolfe RE, Wright SB, Moore R, Bates DW. Who needs a blood culture? a prospectively derived and validated prediction rule.J Emerg Med. 2008; 35(3):255-264
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