Contaminated Blood Culture Specimens in the Emergency Department: Making the Business Case for Improving Quality
1. Scenario.
As part of an organization-wide performance improvement initiative to address the accuracy and efficacy of patient diagnostic testing, you've been asked by the Chief Medical Officer to look into the blood culture contamination rates in the Emergency Department to identify opportunities to improve both clinical and cost-effectiveness, based on your findings and recommendations.
Lab specimens for blood cultures are typically drawn by the ED nurses. However; during times when the ED is overcrowded, the nurses are busy triaging and treating patients. In which case, certified phlebotomists from the lab are used to help draw blood. The staff member who draws the lab can be identified by a discrete number that can be used to track contaminated specimens Data from the reported contaminated specimens for the first 8 months of the fiscal year, delineated by the type of staff member (nurse or phlebotomist) who drew the lab specimen, are shown below in Table 1.
Table 1. Number of Contaminated Blood Culture Specimens by Type of Staff Drawing
| Month |
ED RN Staff Lab Draws |
Phlebotomist Lab Draws |
|
Specimens Drawn |
Number Contaminated |
Specimens Drawn |
Number Contaminated |
| Jul |
553 |
23 |
193 |
3 |
| Aug |
367 |
23 |
139 |
0 |
| Sep |
386 |
16 |
160 |
2 |
| Oct |
403 |
22 |
154 |
2 |
| Nov |
340 |
27 |
158 |
1 |
| Dec |
383 |
28 |
152 |
4 |
| Jan |
408 |
26 |
170 |
1 |
| Feb |
350 |
25 |
138 |
3 |
2. Objectives.
Using the provided article (Bekeris, et al. 2005, Trends in blood culture contamination, Arch Pew; Lab Med, 129) and other available data or assumptions
a. Calculate the estimated annualized cost of the current process for collecting blood culture specimens in the ED?
b. Discuss and identify options to improve quality while reducing total expense?
c. Calculate the projected quality and financial impacts of your recommended actions?