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Cost analysis of blood cultures

Cost analysis of blood cultures. Richard Huynh March 2013. 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

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Cost analysis of blood cultures

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  1. Cost analysis of blood cultures Richard Huynh March 2013

  2. 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

  3. 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.

  4. Results

  5. Of 11 patients: • 55% (6) met criteria • 36% (4) did not meet criteria • 9% (1) appropriately not ordered

  6. 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?

  7. 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.JEmerg Med. 2008; 35(3):255-264 Uptodate

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