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American Academy of Pediatrics
Quality Report

Improvement Methodology Increases Guideline Recommended Blood Cultures in Children With Pneumonia

Eileen Murtagh Kurowski, Samir S. Shah, Joanna Thomson, Angela Statile, Brieanne Sheehan, Srikant Iyer, Christine White and Lilliam Ambroggio
Pediatrics April 2015, 135 (4) e1052-e1059; DOI: https://doi.org/10.1542/peds.2014-2077
Eileen Murtagh Kurowski
Divisions of aEmergency Medicine,
bDepartment of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and
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Samir S. Shah
bDepartment of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and
cHospital Medicine, and
dInfectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
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Joanna Thomson
bDepartment of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and
cHospital Medicine, and
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Angela Statile
bDepartment of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and
cHospital Medicine, and
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Brieanne Sheehan
cHospital Medicine, and
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Srikant Iyer
Divisions of aEmergency Medicine,
bDepartment of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and
eJames M. Anderson Center for Health Systems Excellence, Cincinnati, Ohio
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Christine White
bDepartment of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and
cHospital Medicine, and
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Lilliam Ambroggio
bDepartment of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and
cHospital Medicine, and
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Abstract

BACKGROUND AND OBJECTIVE: A national evidence-based guideline for the management of community-acquired pneumonia (CAP) in children recommends blood cultures for patients admitted with moderate to severe illness. Our primary aim was to increase ordering of blood cultures for children hospitalized with CAP from 53% to 90% in 6 months. The secondary aim was to evaluate the effect of obtaining blood cultures on length of stay (LOS).

METHODS: At a tertiary children’s hospital, interventions to increase blood cultures focused on 3 key drivers and were tested separately in the emergency department and inpatient units by using multiple plan-do-study-act cycles. The impact of the interventions was tracked over time on run charts. The association of ordering blood cultures and LOS was estimated by using linear regression models.

RESULTS: Within 6 months, the percentage of patients admitted with CAP who had blood cultures ordered increased from 53% to 100%. This change has been sustained for 12 months. Overall, 239 (79%) of the 303 included patients had a blood culture ordered; of these, 6 (2.5%) were positive. Patients who had a blood culture did not have an increased LOS compared with those without a blood culture.

CONCLUSIONS: Quality improvement methods were used to increase adherence to evidence-based national guidelines for performing blood cultures on children hospitalized with CAP; LOS did not increase. These results support obtaining blood cultures on all patients admitted with CAP without negative effects on LOS in a setting with a reliably low false-positive blood culture rate.

  • pneumonia
  • blood culture
  • pediatric
  • Accepted December 1, 2014.
  • Copyright © 2015 by the American Academy of Pediatrics

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Pediatrics
Vol. 135, Issue 4
1 Apr 2015
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Improvement Methodology Increases Guideline Recommended Blood Cultures in Children With Pneumonia
Eileen Murtagh Kurowski, Samir S. Shah, Joanna Thomson, Angela Statile, Brieanne Sheehan, Srikant Iyer, Christine White, Lilliam Ambroggio
Pediatrics Apr 2015, 135 (4) e1052-e1059; DOI: 10.1542/peds.2014-2077

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Improvement Methodology Increases Guideline Recommended Blood Cultures in Children With Pneumonia
Eileen Murtagh Kurowski, Samir S. Shah, Joanna Thomson, Angela Statile, Brieanne Sheehan, Srikant Iyer, Christine White, Lilliam Ambroggio
Pediatrics Apr 2015, 135 (4) e1052-e1059; DOI: 10.1542/peds.2014-2077
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