Clinical question: Do diagnostic stewardship interventions in times of crisis lead to sustained change in blood-culture ordering practices?
Background: It is estimated that a third of all blood cultures ordered in the hospital are repeat cultures for known infections, though guidelines support only the use of repeat cultures for specific organisms or in certain clinical scenarios. Unnecessary blood cultures lead to increased cost and potential direct patient harm.
Study design: A quasi-experimental study with retrospective chart review
Setting: One tertiary care academic center and nine community hospitals in Maine
Synopsis: A total of 940 adult patients with bloodstream infections were evaluated before and after stewardship interventions, including clinician education and clinical decision support within the blood culture order, which were implemented in response to a blood culture shortage. The percentage of repeat cultures drawn for gram-negative rod and streptococcal infections decreased from 51.8% to 24.8% (P <.001). However, this improvement was not sustained after the shortage ended and blood culture orders returned to their default status, with repeat culture orders rising to 47.0%.
Bottom Line: Interventions aimed at achieving diagnostic stewardship during a time of shortage increase evidence-based care and reduce low-value testing.
Citation: Ezran C, et al. Shortage as a catalyst for high-value care: evaluation of a blood culture stewardship intervention driven by supply chain disruption. J Hosp Med. 2025. doi:10.1002/jhm.70158.
Dr. Carson is a hospitalist in the department of hospital medicine at the Cleveland Clinic in Cleveland.