New checklist cuts unnecessary blood draws by 50%

A procedural checklist created by researchers at Johns Hopkins Medicine in Baltimore reduced blood cultures drawn from pediatric patients in the intensive care unit by approximately half, according to a recent study published in JAMA Pediatrics.

While sepsis and septic shock are relatively common and can be fatal among pediatric patients, blood draws ordered by clinicians to identify the condition produce false positives as much as 50 percent of the time. Blood draws can place added stress on pediatric patients and lead to unnecessary treatments.

"It is common for children in the ICU to have a fever and get a blood culture. Sometimes, the culture is positive, but before the clinician can order treatment, the child clears the fever on his or her own," said Charlotte Woods-Hill, MD, attending physician in the division of critical care medicine at the Children's Hospital of Philadelphia. "The clinicians are left with the decision of what to do with that information, so to be safe, they treat them. We have had a number of kids who are ready to go home and the next thing you know, they are spending two more weeks in the hospital getting IV antibiotics because a blood culture was positive."

To reduce the occurrence of unnecessary blood draws, a collaborative team of nurses, vascular access specialists and physicians across specialties created a checklist of protocols for fever assessment, along with a decision-making flow chart. Both tools were disseminated to clinicians at Johns Hopkins's pediatric ICU.

In the year prior to the introduction of the tools, there were 2,204 patient visits to the pediatric ICU and 1,807 blood cultures drawn. After intervention, there 984 blood cultures drawn for 2,356 patient visits, almost cutting the number of blood cultures per patient day by half.

"Clinicians are uneasy when asked to do less, especially when facing an acute condition like sepsis," said James Fackler, MD, associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. "We hope that the tools developed by our team will ease these concerns by offering guidelines for a clear and effective path to diagnosis."

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