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Bright STAR Collaborative

The Blood Culture Improvement Guidelines and Diagnostic Stewardship for Antibiotic Reduction in Critically Ill Children, or Bright STAR Collaborative, is a quality improvement project to optimize the use of blood cultures in patients in the PICU. 

The American Board of Pediatrics (ABP) recently approved the Johns Hopkins University School of Medicine as the coordinating center for physicians who can now obtain ABP Maintenance of Certification credit through involvement in the Bright STAR Collaborative.

Background

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.

  • Clinical decision support tools included a fever/sepsis screening checklist and a blood culture decision algorithm.
  • It helped reduced blood culture use in the Children’s Center PICU by 46 percent, with similar rates of mortality and septic shock before and after implementation.
  • This program was successfully implemented by two other PICUs, resulting in a 32 percent overall reduction in blood culture use.

Goal

The goal of this multicenter project is to identify strategies to implement this diagnostic stewardship model on a large scale and determine if this strategy reduces antibiotic use.

  • Research has shown that the yield of blood cultures for detecting bacteremia is as low as 5 percent to 15 percent, with a 50 percent false positive rate.
  • Excessive or inappropriate blood cultures may lead to unnecessary antibiotics and a longer hospital stay.
  • Repeated entry into central venous catheters to obtain blood cultures may contribute to unit-wide issues with central line associated blood stream infections (CLABSIs).
  • In addition, the yield of blood cultures (especially surveillance or repeated testing) in critically ill patients may be quite low.

Collaboration

Unit leadership at each site works closely with the Bright STAR team. Sites in the collaborative will develop and implement tools for clinicians to use when deciding if a patient should have a blood culture. These tools help the medical team decide if a blood culture should be obtained and from which source (a peripheral venipuncture versus from a central line). The Bright STAR team will track rates and sources of cultures along with patient outcomes to monitor project results.

 

Collaborative Sites*

  1. Boston Children’s Hospital
  2. The Children's Hospital of Philadelphia
  3. Children’s Healthcare of Atlanta
  4. Cleveland Clinic Children’s
  5. Dell Children’s Medical Center
  6. Doernbecher Children's Hospital
  7. Le Bonheur Children’s Hospital
  8. Ann & Robert H. Lurie Children’s Hospital of Chicago
  9. Intermountain Primary Children’s Medical Center
  10. Rainbow Babies and Children's Hospital
  11. Lucile Packard Children’s Hospital
  12. Seattle Children's Hospital
  13. St. Jude Children's Hospital
  14. Children’s Hospital St. Louis
  15. Children’s Hospital Association

*Evolving as of Feb. 19, 2018.

Publications

  1. Woods-Hill CZ, Fackler J, Nelson McMillan K, Ascenzi J, Martinez DA, Toerper MF, Voskertchian A, Colantuoni E, Klaus SA, Levin S, Milstone AM. Association of a Clinical Practice Guideline With Blood Culture Use in Critically Ill Children. JAMA Pediatr. 2017 Feb 1;171(2):157-164. doi: 10.1001/jamapediatrics.2016.3153. PubMed ID: 27942705.
  2. Xie A, Woods-Hill CZ, King AF, Enos-Graves H, Ascenzi J, Gurses AP, Klaus SA, Fackler JC, Milstone AM. Work System Assessment to Facilitate the Dissemination of a Quality Improvement Program for Optimizing Blood Culture Use: A Case Study Using a Human Factors Engineering Approach. J Pediatric Infect Dis Soc. 2017 Nov 20. doi: 10.1093/jpids/pix097. PubMed ID: 29165616.

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