Children in the pediatric intensive care unit (PICU) are typically among the sickest patients in the hospital. For physicians everywhere, testing and ordering routine blood draws is an important part of making a diagnosis. However, collecting several blood draws, can lead to additional concerns, like unnecessary antibiotic use, a prolonged stay at the hospital, inflation of health care costs or contribute to antibiotic resistance. 

In an effort to help clinicians reduce blood draws for PICU patients, 14 PICUs across the country participated in a Johns Hopkins Children’s Center-led quality improvement collaborative, known as the BrighT STAR Collaborative, from 2017–2020. In the study, each participating PICU developed an implementation plan and created a unique clinical decision support tool to guide blood culture practice. During the project period, sites demonstrated a 33% reduction in blood culture rates and a 13% reduction in antibiotic use.

Researchers initiated a follow-up study 24 months after the formal project period to determine whether participating sites sustained the reduced blood draw rates. Findings from the latest study, published September 11 in JAMA Pediatrics, show that the collaborative’s efforts continued to successfully reduce blood culture rates by 27% two years later.

Aaron Milstone, M.D., M.H.S., a pediatric infectious diseases specialist at Johns Hopkins Children’s Center, and his investigative team believe diagnostic stewardship programs like the BrighT STAR collaborative can help facilitate significant and sustained decreases in blood culture rates, but further work is needed to determine optimal strategies for implementing and sustaining such rates in additional centers.