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Journal of Clinical Microbiology, April 2009, p. 1021-1024, Vol. 47, No. 4
0095-1137/09/$08.00+0     doi:10.1128/JCM.02162-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Impact of Blood Cultures Drawn by Phlebotomy on Contamination Rates and Health Care Costs in a Hospital Emergency Department{triangledown}

Rita M. Gander,1,2* Linda Byrd,2 Michael DeCrescenzo,3 Shaina Hirany,2 Michelle Bowen,2 and Judy Baughman2

Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas,1 Department of Pathology,2 Department of Performance Improvement, Parkland Health & Hospital System, Dallas, Texas3

Received 11 November 2008/ Returned for modification 24 December 2008/ Accepted 16 January 2009

We conducted a prospective comparison of blood culture contamination rates associated with dedicated phlebotomists and nonphlebotomy staff in the emergency department (ED) at Parkland Memorial Hospital in Dallas, TX. In addition, hospital charges and lengths of stay were determined for patients with negative, false-positive, and true-positive blood culture results. A total of 5,432 blood culture collections from two ED areas, the western wing of the ED (ED west) and the nonwestern wing of the ED (ED nonwest), were evaluated over a 13-month period. Phlebotomists drew 2,012 (55%) of the blood cultures in ED west while nonphlebotomy staff drew 1,650 (45%) in ED west and 1,770 (100%) in ED nonwest. The contamination rates of blood cultures collected by phlebotomists were significantly lower than those collected by nonphlebotomists in ED west (62/2,012 [3.1%] versus 122/1,650 [7.4%]; P < 0.001). Similar results were observed when rates between phlebotomists in ED west and nonphlebotomy staff in ED nonwest were compared (62/2,012 [3.1%] versus 100/1,770 [5.6%]; P < 0.001). Comparison of median patient charges between negative and false-positive episodes ($18,752 versus $27,472) showed $8,720 in additional charges per contamination event while the median length of stay increased marginally from 4 to 5 days. By utilizing phlebotomists to collect blood cultures in the ED, contamination rates were lowered to recommended levels, with projected reductions in patient charges of approximately $4.1 million per year.

* Corresponding author. Mailing address: Department of Pathology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9073. Phone: (214) 648-3120. Fax: (214) 648-8037. E-mail: rita.gander{at}utsouthwestern.edu

{triangledown} Published ahead of print on 26 January 2009.

Journal of Clinical Microbiology, April 2009, p. 1021-1024, Vol. 47, No. 4
0095-1137/09/$08.00+0     doi:10.1128/JCM.02162-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.





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