Blog Post

Chart of the Day: Strategies to Reduce Overuse of Clinical Services

The Case of Pediatric Antibiotic Use

May 6, 2022

By:

Charlotte Woods-Hill, MD, MSHP

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Figure 1. Monthly Blood Cultures per 1000 Patient-Days for Each of the 14 Bright STAR (Testing Stewardship for Antibiotic Reduction) Sites Monthly blood cultures per 1000 patient-days for each of the 14 Bright STAR sites before and after implementation (24 and 18 months, respectively). The mean monthly average rate over time was estimated using a smoothing spline with 4 degrees of freedom.

Blood culture tests are commonly overused in the pediatric intensive care unit, a practice that leads to unnecessary antibiotic use and contributes to antibiotic resistance. Optimizing blood culture practices through diagnostic stewardship may reduce unnecessary blood cultures and antibiotics.

In a new study in JAMA Pediatrics, my coauthors and I report on a multicenter diagnostic stewardship intervention designed to optimize and reduce the use of blood cultures for critically ill children. The intervention involved 14 pediatric ICUs—all members of a collaborative called Bright STAR. When we assessed the effects of the Bright STAR intervention in these ICUs after 24 months, we found it reduced blood cultures by 33% and antibiotic use by 13% without changing safety or balancing metrics, such as mortality or sepsis.

How did we do it? We used human factors engineering to understand blood culture practices across the study hospitals, and then we developed site-specific new clinical tools informed by key stakeholder perspectives and unique patient needs. Throughout the project, we assessed elements of both work system factors and quality improvement infrastructure, and we used customized implementation strategies to integrate the clinical tools at each site.

This study points to a promising strategy to change clinical practice, including one of the hardest changes to make—stopping old habits.

The study, “Association of Diagnostic Stewardship for Blood Cultures in Critically Ill Children With Culture Rates, Antibiotic Use, and Patient Outcomes,” was published May 2, 2022, in JAMA Pediatrics. Authors include Charlotte Z Woods-Hill, Elizabeth A. Colantuoni, Danielle W. Koontz, Annie Voskertchian, Anping Xie, Cary Thurm, Marlene R. Miller, James C. Fackler, Aaron M. Milstone, and the Bright STAR authorship group.