Optimizing Fill Volume of Blood Cultures Submitted in a Children’s Hospital Emergency Room

Abstract

PURPOSE: Non-adherence to weight-based blood culture volume guidelines has been an ongoing problem and may be associated with lower blood culture positivity rates and higher contamination rates. To increase sufficient fill volume compliance with weight-based blood culture fill volumes in the Emergency Department at the Monroe Carell Jr. Children’s Hospital at Vanderbilt University Medical Center from 19% of samples collected to 50% according to the institutional weight-based blood culture volume guidelines over a 1-month period following staff educational interventions. METHODS: This quality improvement project focused on pediatric patients from birth to 18 years old. Blood culture bottles were collected and manually weighed to determine the fill volume and guideline concordance, initially from July to August 2023 and again following educational implementation from January to February 2024. Strategies to improve fill volumes included educational flyers/handouts, discussion conducted at a staff meeting, and ongoing new staff hospital-based orientation. RESULTS: 612 blood culture bottles were weighed institutional-wide (300 pre and 312 post-intervention). Of those, 210 were from the ED (90 pre and 120 post-intervention). Analysis of pre- and post-implementation data showed improvement in appropriate fill volume and bottle use. Before the educational intervention, only 16% of blood culture bottles were filled correctly, and 68% used the proper bottle. The educational intervention increased the percentage of correctly filled bottles to 22% and proper bottle use to 84%. Results indicate that underfilled blood cultures are common, but that operational and educational strategy can result in sustained improvement. Educating medical personnel is a simple and effective way to optimize the filling volume of blood culture bottles. IMPLICATIONS FOR PRACTICE: Implications for the future include conducting another PDSA cycle after further education interventions, analyzing other departments to understand the institution at large, and considering a double-check in the EMR to verify the correct bottle, weight, and fill volume before blood is drawn.