Solitary blood cultures - A College of American Pathologists Q-Probes study of 132,778 blood culture sets in 333 small hospitals

Objective.-To determine the frequency with which solitary blood culture sam ples were submitted to laboratories serving small hospitals and to ascertai n whether certain hospital practices relating to the performance of blood c ultures were associated with lower solitary blood culture rates (SBCRs). Design.-Participants in the College of American Pathologists Q-Probes labor atory quality improvement program collected data prospectively on the numbe rs of solitary blood culture sets from adult patients submitted to their la boratories and answered questions about their institutions' practice charac teristics relating to the collection of blood culture specimens. Setting and Participants.-Three hundred thirty-three public and private ins titutions with a median occupied bed size of 57. Participants were located in the United States (n = 329), Canada (n = 3), and Australia (n = 1). Main Outcome Measure.-The solitary blood culture rate was defined as the nu mber of instances in which only 1 blood culture venipuncture was performed on an individual patient during a 24-hour period divided by the total numbe r of blood culture venipunctures that were performed during the study perio d. Results.- Participants submitted data on 132778 adult patient blood culture sets. The SBCRs were 3.4% or less in the top-performing 10% of participati ng institutions (90th percentile and above), 12.7% in the midrange of parti cipating institutions (50th percentile), and 42.5% or more in the bottom-pe rforming 10% of participating institutions (10th percentile and below). In half the participating institutions, the SBCRs for inpatients were 8.3% or less and for outpatients, 22% or less. Solitary blood culture rates were lo wer for institutions in which phlebotomists rather than nonphlebotomists ro utinely collected blood culture specimens, in which internal policies requi red drawing at least 2 blood culture sets, in which hospital personnel cont acted clinicians when their laboratories received requests for solitary blo od culture sets, and in which quality control programs monitored SBCRs rout inely. Conclusions.-Hospitals can achieve SBCRs under 5%. Those hospitals with par ticularly high SBCRs may lower their rates by altering certain institutiona l practices.