title: Improvement methodology increases guideline recommended blood cultures in children with pneumonia.
abstract: OBJECTIVE
  A national evidence-based guideline for the management of community-acquired pneumonia (CAP) in children recommends blood cultures for patients admitted with moderate to severe illness. Our primary aim was to increase ordering of blood cultures for children hospitalized with CAP from 53% to 90% in 6 months. The secondary aim was to evaluate the effect of obtaining blood cultures on length of stay (LOS).
  
  
  METHODS
  At a tertiary children's hospital, interventions to increase blood cultures focused on 3 key drivers and were tested separately in the emergency department and inpatient units by using multiple plan-do-study-act cycles. The impact of the interventions was tracked over time on run charts. The association of ordering blood cultures and LOS was estimated by using linear regression models.
  
  
  RESULTS
  Within 6 months, the percentage of patients admitted with CAP who had blood cultures ordered increased from 53% to 100%. This change has been sustained for 12 months. Overall, 239 (79%) of the 303 included patients had a blood culture ordered; of these, 6 (2.5%) were positive. Patients who had a blood culture did not have an increased LOS compared with those without a blood culture.
  
  
  CONCLUSIONS
  Quality improvement methods were used to increase adherence to evidence-based national guidelines for performing blood cultures on children hospitalized with CAP; LOS did not increase. These results support obtaining blood cultures on all patients admitted with CAP without negative effects on LOS in a setting with a reliably low false-positive blood culture rate.
authors.affiliation: Divisions of Emergency Medicine, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and eileen.murtagh-kurowski@cchmc.org.
authors.forename: Eileen
authors.initials: E
authors.lastname: Murtagh Kurowski
authors.affiliation: Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and Hospital Medicine, and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and Hospital Medicine, and.
authors.forename: Joanna
authors.initials: J
authors.lastname: Thomson
authors.affiliation: Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and Hospital Medicine, and.
authors.forename: Angela
authors.initials: A
authors.lastname: Statile
authors.affiliation: Hospital Medicine, and.
authors.forename: Brieanne
authors.initials: B
authors.lastname: Sheehan
authors.affiliation: Divisions of Emergency Medicine, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and James M. Anderson Center for Health Systems Excellence, Cincinnati, Ohio.
authors.forename: Srikant
authors.initials: S
authors.lastname: Iyer
authors.affiliation: Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and Hospital Medicine, and.
authors.forename: Christine
authors.initials: C
authors.lastname: White
authors.affiliation: Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and Hospital Medicine, and.
authors.forename: Lilliam
authors.initials: L
authors.lastname: Ambroggio
mesh_terms: D000046:Academic Medical Centers; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000188:drug therapy; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007318:Inservice Training; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D009820:Ohio; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000188:drug therapy; D058996:Quality Improvement / Q000706:statistics & numerical data*; D014600:Utilization Review / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents
keywords: blood culture; pediatric; pneumonia