Dataset Information

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

ABSTRACT:

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.

SUBMITTER: Woods-Hill CZ

PROVIDER: S-EPMC6221585 | biostudies-literature | 2018 Sep-Oct

REPOSITORIES: biostudies-literature

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Publications

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

Woods-Hill Charlotte Z CZ Lee Laura L Xie Anping A King Anne F AF Voskertchian Annie A Klaus Sybil A SA Smith Michelle M MM Miller Marlene R MR Colantuoni Elizabeth A EA Fackler James C JC Milstone Aaron M AM

Pediatric quality & safety 20180901 5

<h4>Introduction</h4>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.<h4>Methods</h4>Three pediatric intensive care units (14 bed medical/cardiac; 28 bed medical; 22 bed cardiac) in 2 institutions adapted and implemented ...[more]

PMID: 30584639

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Project description:By virtue of being in a developing country with ongoing expanding of the healthcare system, establishing or at least renovating a Pediatric critical care unit (PICU) has become a necessity. As intensivists and healthcare providers, we excel at our job as clinicians; however, we perform less than perfect when it comes to participating in establishing new PICUs and deliberately building and designing an EBM and patient-centered PICU with a complete understanding of the technical and non-clinical processes during commissioning or operational phases like construction, physical layout (blueprint), Biomedical engineering aspects, equipment, supply, and work-environment enhancement. If all healthcare providers -and especially intensivists- avoid being involved actively in PICUs designing process at their institution, they will miss an opportunity to gain a new perspective as well as they might contribute to a fragmented process of ICU design and a suboptimal result that might impact the PICU environment, patient journey and eventually the quality of care in that ICU. The PICU designing processes should be handled via a multi-professional team approach in an integrated -not parallel- manner that includes clinical and non-clinical personnel. Therefore, the processes will be more integrated, and they will finish the project efficiently, effectively, safely, and patient-centered way. This paper is an expert opinion and literature review that describes a conceptual framework to guide simple and practical mental processes in establishing and designing processes for new PICUs in developing countries. We called this preparedness tool: the 4S framework (system, space, staff, and stuff). It is a well-known preparedness tool that is commonly used in planning new projects by project leaders. Therefore, we utilized it in establishing a new PICU intended to meet the national and international accreditation standards and requirements. This unique preparedness tool will help establish an easy conceptual framework for all healthcare providers to grasp the complex -clinical and non-clinical- processes of establishing new PICUs and develop a holistic approach to this complex project. Note: The authors had leading roles in establishing or renovating many PICUs in Saudi Arabia, in both private and governmental hospitals, and would like to share their novel conceptual framework for establishing new PICUs in developing countries.

Project description:ObjectivesMore children are surviving critical illness but are at risk of residual or new health conditions. An evidence-informed and stakeholder-recommended core outcome set is lacking for pediatric critical care outcomes. Our objective was to create a multinational, multistakeholder-recommended pediatric critical care core outcome set for inclusion in clinical and research programs.DesignA two-round modified Delphi electronic survey was conducted with 333 invited research, clinical, and family/advocate stakeholders. Stakeholders completing the first round were invited to participate in the second. Outcomes scoring greater than 69% "critical" and less than 15% "not important" advanced to round 2 with write-in outcomes considered. The Steering Committee held a virtual consensus conference to determine the final components.SettingMultinational survey.PatientsStakeholder participants from six continents representing clinicians, researchers, and family/advocates.Measurements and main resultsOverall response rates were 75% and 82% for each round. Participants voted on seven Global Domains and 45 Specific Outcomes in round 1, and six Global Domains and 30 Specific Outcomes in round 2. Using overall (three stakeholder groups combined) results, consensus was defined as outcomes scoring greater than 90% "critical" and less than 15% "not important" and were included in the final PICU core outcome set: four Global Domains (Cognitive, Emotional, Physical, and Overall Health) and four Specific Outcomes (Child Health-Related Quality of Life, Pain, Survival, and Communication). Families (n = 21) suggested additional critically important outcomes that did not meet consensus, which were included in the PICU core outcome set-extended.ConclusionsThe PICU core outcome set and PICU core outcome set-extended are multistakeholder-recommended resources for clinical and research programs that seek to improve outcomes for children with critical illness and their families.

Dataset Information

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

Introduction

Methods

Results

Conclusions

Publications

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

Similar Datasets

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