Spend a little, save a lot?
Many hospitals, including mine, have struggled with high rates of contaminated blood cultures. After several years and a ton of work, we have been able to reduce our contamination rate by over half. Contamination rates in the Emergency Department (ED) are especially important since EDs draw a significant proportion of the blood cultures in the hospital. My hospital does not have a phlebotomy team and I have often wondered how much improvement we could gain with one.
An interesting study from Parkland Hospital has been published in the April edition of the Journal of Clinical Microbiology which shows that blood cultures drawn by phlebotomists in the ED were significantly less likely to be contaminated than those drawn by non-phlebotomists (roughly 3% vs. 6-7%). The authors then compared median hospital charges between the patients with contaminated blood cultures and those with negative blood cultures and ascribed the $8,720 difference in charges to the contaminated blood culture. This methodology has a great deal of potential for bias since the patients with contaminated cultures were not matched in any way to those with negative blood cultures. The authors contend that avoiding just 5 contaminated cultures would pay for one full time phlebotomist. While I do worry about this conclusion, even if the authors erred by a factor of 10 in their estimates of attributable charges, reducing the rate of contaminated blood cultures from 6% to 3% in an ED that draws 13,800 cultures per year (as does Parkland), would still pay for 9 phlebotomists at $40,000 annually for each. The findings were strong enough for Parkland to hire round-the-clock phlebotomists in their ED, and because of this paper I hope to convince my hospital to do the same.
An interesting study from Parkland Hospital has been published in the April edition of the Journal of Clinical Microbiology which shows that blood cultures drawn by phlebotomists in the ED were significantly less likely to be contaminated than those drawn by non-phlebotomists (roughly 3% vs. 6-7%). The authors then compared median hospital charges between the patients with contaminated blood cultures and those with negative blood cultures and ascribed the $8,720 difference in charges to the contaminated blood culture. This methodology has a great deal of potential for bias since the patients with contaminated cultures were not matched in any way to those with negative blood cultures. The authors contend that avoiding just 5 contaminated cultures would pay for one full time phlebotomist. While I do worry about this conclusion, even if the authors erred by a factor of 10 in their estimates of attributable charges, reducing the rate of contaminated blood cultures from 6% to 3% in an ED that draws 13,800 cultures per year (as does Parkland), would still pay for 9 phlebotomists at $40,000 annually for each. The findings were strong enough for Parkland to hire round-the-clock phlebotomists in their ED, and because of this paper I hope to convince my hospital to do the same.
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