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Research Snapshot Theater: Quality and Patient Safety, Pediatric II

Improving Evidence-Based Blood Culture Utilization in the Pediatric Intensive Care Unit (PICU)

Monday, March 23, 2026
9:00 AM - 10:00 AM Central Time
Location: Connections Central - RST 10
  • VF

    Vanessa Ford, MD

    Duke University Hospital

    Disclosure information not submitted.

  • IE

    Imran Elmaarouf, DO

    Resident Physician
    Duke University Hospital

    Disclosure information not submitted.

  • EF

    Elyssa Farr, DO

    Resident Physician
    Duke University Hospital

    Disclosure information not submitted.

  • AF

    Ann Marie Flusche, N/A

    Medical Student
    Duke University Hospital

    Disclosure information not submitted.

  • AF

    Anna Fritz, DNP, BSN, RN

    Nurse Practitioner
    Ann & Robert H Lurie Children's Hospital

    Disclosure information not submitted.

  • IK

    Ibukunoluwa Kalu, MD

    Associate Professor of Pediatrics, Infectious Disease Physician
    Duke University Hospital

    Disclosure information not submitted.

  • OA

    Omar Alibrahim, MD, FCCM

    Associate Professor of Pediatrics
    Duke University Medical Center

    Disclosure information not submitted.

  • HM

    Heather McLean, MD

    Professor of Pediatrics , Quality Vice Chair
    Duke University Hospital

    Disclosure information not submitted.

Introduction: Blood cultures drawn from central catheters (CCs) may yield pathogenic bacteria but can also grow clinically insignificant bacteria from catheter colonization. Optimizing diagnostic blood culture stewardship promotes high-value, cost-conscious care, and plays a critical role in minimizing patient harm - such as unnecessary antibiotic exposure and prolonged hospital length of stay. This quality improvement project aimed to increase the proportion of blood cultures collected peripherally from 74% to >85% within five months. A secondary aim was to decrease the total number of blood cultures collected each month by 33%, aligned with benchmarks set by the BrighT STAR Collaborative.


Methods: We reviewed 3 months of data to estimate baseline blood culture collection rates per culture source – peripheral or CC. We surveyed physicians and nurse practitioners to assess the rationale behind ordering blood cultures from CCs. An interdisciplinary team created a key driver diagram to guide efforts in increasing the use of peripheral blood cultures. Our interventions included repeated multidisciplinary education, weekly feedback to ordering providers, development of an escalation pathway for difficult percutaneous venous sticks, and creation of an evidence-based algorithm. The proportion of peripheral blood cultures and total monthly blood cultures were tracked using control and run charts. Antibiotic usage was monitored as a balancing measure.


Results: The baseline proportion of blood cultures collected from a peripheral source was 74%. Common reasons for CC cultures included difficult peripheral access (78%), comfort concerns (17%), consultant requests (67%), and suspected CLABSI. After interventions, peripheral blood culture rates increased from 74% to 87%, and the total monthly blood cultures decreased by 22% over the same 5-month period, both resulting in statistical process control shifts. Antibiotic usage remained stable.


Conclusions: Repeated education and process standardization led to successful reduction in blood culture utilization. Next steps include ensuring sustainability and monitoring adherence to our new pathway.
Quality and Relevance: Blood culture stewardship reduces the risk of patient harm from unnecessary blood cultures and antibiotic use, thereby improving cost-conscious care.