title: Impact of blood cultures drawn by phlebotomy on contamination rates and health care costs in a hospital emergency department.
abstract: We conducted a prospective comparison of blood culture contamination rates associated with dedicated phlebotomists and nonphlebotomy staff in the emergency department (ED) at Parkland Memorial Hospital in Dallas, TX. In addition, hospital charges and lengths of stay were determined for patients with negative, false-positive, and true-positive blood culture results. A total of 5,432 blood culture collections from two ED areas, the western wing of the ED (ED west) and the nonwestern wing of the ED (ED nonwest), were evaluated over a 13-month period. Phlebotomists drew 2,012 (55%) of the blood cultures in ED west while nonphlebotomy staff drew 1,650 (45%) in ED west and 1,770 (100%) in ED nonwest. The contamination rates of blood cultures collected by phlebotomists were significantly lower than those collected by nonphlebotomists in ED west (62/2,012 [3.1%] versus 122/1,650 [7.4%]; P < 0.001). Similar results were observed when rates between phlebotomists in ED west and nonphlebotomy staff in ED nonwest were compared (62/2,012 [3.1%] versus 100/1,770 [5.6%]; P < 0.001). Comparison of median patient charges between negative and false-positive episodes ($18,752 versus $27,472) showed $8,720 in additional charges per contamination event while the median length of stay increased marginally from 4 to 5 days. By utilizing phlebotomists to collect blood cultures in the ED, contamination rates were lowered to recommended levels, with projected reductions in patient charges of approximately $4.1 million per year.
authors.affiliation: Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9073, USA. rita.gander@utsouthwestern.edu
authors.forename: Rita M
authors.initials: RM
authors.lastname: Gander
authors.forename: Linda
authors.initials: L
authors.lastname: Byrd
authors.forename: Michael
authors.initials: M
authors.lastname: DeCrescenzo
authors.forename: Shaina
authors.initials: S
authors.lastname: Hirany
authors.forename: Michelle
authors.initials: M
authors.lastname: Bowen
authors.forename: Judy
authors.initials: J
authors.lastname: Baughman
mesh_terms: D000328:Adult; D000368:Aged; D001419:Bacteria / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000175:diagnosis*; D001769:Blood / Q000382:microbiology*; D001800:Blood Specimen Collection / Q000379:methods*; D003951:Diagnostic Errors / Q000191:economics*; D004636:Emergency Service, Hospital; D004866:Equipment Contamination / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018962:Phlebotomy / Q000009:adverse effects* / Q000191:economics; D011446:Prospective Studies