Naureckas Li Caitlin, Patel Sameer, Collins Catherine
Division of Infectious Diseases, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL, 60611, USA.
Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Pediatr Cardiol. 2024 Aug 12. doi: 10.1007/s00246-024-03616-4.
Bacteremia can be life-threatening, and highly medicalized patients, such as those with complex congenital heart disease, are at high risk. Infectious diseases (ID) consultation is associated with improved outcomes in bacteremia. We noted an opportunity for improvement in management of positive blood cultures in our cardiac care unit (CCU). We completed a quality improvement project that included a single plan-do-study-act cycle consisting of a policy of routine ID consultation for all positive blood cultures events in the CCU. Our outcome measure of interest was percentage of appropriately managed blood culture events, the process measure was percentage of blood culture events for which the ID service was formally consulted, and the balancing measure was number of individual patients for whom the ID service was formally consulted. Appropriate antimicrobial management was determined via chart review by an ID physician. Data were analyzed via run chart and simple statistics. Following the intervention, the rate of appropriately managed positive blood culture events increased from a baseline of 86% to 98%, and the rate of ID consultation for these events increased from 75% to 98%. A shift was noted in run charts for both the outcome and process measures. There was an increase in patients for whom the ID service was consulted throughout the entire study period. We successfully implemented mandatory ID consultations in a CCU to increase proportion of appropriately managed blood cultures. While this intervention cannot be universally applied, others may find it useful in selected scenarios.
菌血症可能危及生命，而患有复杂先天性心脏病等高度依赖医疗护理的患者风险很高。感染病（ID）会诊与改善菌血症的治疗结果相关。我们注意到在我们的心脏监护病房（CCU）中，血培养阳性的管理有改进的空间。我们完成了一个质量改进项目，该项目包括一个单周期的计划-执行-研究-行动循环，其中包含一项针对CCU中所有血培养阳性事件进行常规ID会诊的政策。我们感兴趣的结果指标是血培养事件得到适当管理的百分比，过程指标是正式咨询ID服务的血培养事件的百分比，平衡指标是正式咨询ID服务的个体患者数量。由ID医生通过病历审查确定适当的抗菌药物管理。通过运行图和简单统计分析数据。干预后，血培养阳性事件得到适当管理的比例从基线的86%提高到了98%，这些事件的ID会诊比例从75%提高到了98%。结果指标和过程指标的运行图都出现了变化。在整个研究期间，咨询ID服务的患者有所增加。我们在CCU成功实施了强制性ID会诊，以提高血培养得到适当管理的比例。虽然这种干预措施不能普遍适用，但其他机构可能会发现在特定情况下它很有用。
