The BrighT STAR (Testing STewardship to reduce Antibiotic Resistance) Collaborative includes children’s hospitals across the United States with a common mission of reducing overtesting in critically ill children.

Background

Formed in 2018, the BrighT STAR Collaborative is a prospective multicenter quality improvement (QI) collaborative that includes children’s hospitals in 17 states across the U.S. Participating hospitals share the common goal of implementing diagnostic stewardship interventions — appropriate use of laboratory testing — to reduce bacterial culture overuse.

Objectives

Diagnostic stewardship is an essential component of our health care system’s advancement to a high- value care model and provides a novel strategy to reduce overuse. Diagnostic stewardship involves altering how providers order, perform and report diagnostic tests. The goal of this multicenter collaborative is to implement diagnostic stewardship strategies on a large scale and determine if this can reduce unnecessary antibiotic treatment. The long-term goal is to safely avoid unnecessary testing and treatment to improve patient care, decrease antibiotic resistance and provide high-value care.

Blood Cultures

In January 2014, pediatricians at Johns Hopkins Children’s Center developed and implemented a clinical practice strategy to guide clinicians in the use of blood cultures when evaluating patients with signs and symptoms of sepsis (1). Between 2016 and 2018, the program was first extended to Johns Hopkins All Children’s Hospital and University of Virginia Children’s Hospital and then expanded to 15 BrighT STAR collaborative hospitals. Each BrighT STAR hospital developed and implemented a local QI program to improve blood culture use within their ICU. Implementation was guided by a modifiable five-part approach, incorporating principles of the Comprehensive Unit-based Safety Program. Thus far, there has been a 31% overall reduction in blood culture use across the collaborative. This collaborative also contributed to development of consensus recommendations for blood culture use in pediatric intensive care unit (PICU) patients — which will be released in the coming months.

Respiratory Cultures

In 2018, pediatricians at Johns Hopkins Children’s Center developed and implemented a clinical practice strategy to guide clinicians in the use of respiratory cultures when evaluating mechanically ventilated patients for respiratory infections (9). In 2021, this respiratory culture project will expand across the BrighT STAR collaborative, using a similar multicenter QI framework. Guided by a Translating Evidence into Practice model, each collaborative site will develop and implement QI initiatives to improve respiratory culture practices. The BrighT STAR team will support the collaborative, as well as collect aggregate data on respiratory culture rates and clinical outcomes. This collaborative work will be the foundation to develop evidence-based toolkits other hospitals can use to improve respiratory culture practices in the future.

Collaboration

Multidisciplinary quality improvement teams at each site work closely with the BrighT STAR coordinating team. Sites in the collaborative develop and implement tools for clinicians to use when deciding whether or not a patient should have a blood or respiratory culture. These tools help the medical team decide if a culture should be obtained, how frequently, and how to collect the sample. The BrighT STAR team tracks culture rates and patient outcomes to monitor project results.