Shortage as a catalyst for high-value care: Evaluation of a blood culture stewardship intervention driven by supply chain disruption

Abstract

Background

Clinicians often repeat blood cultures in hospitalized, bacteremic patients in excess. Unnecessary cultures have negative impacts, including increased length of hospitalization and environmental waste.

Objective

To evaluate the impact of diagnostic stewardship interventions on repeat blood culture ordering in bacteremic patients during the BD Bactec blood culture bottle shortage in 2024.

Methods

We performed a quasi-experimental study including a pre, post, and sustainment phase of adult patients hospitalized with a bloodstream infection at the MaineHealth healthcare system from March to November 2024.

Results

Nine hundred and forty patients met inclusion criteria. Stewardship interventions reduced repeat blood cultures in patients with Gram-negative rod and Streptococcal bacteremia from 52% to 25% (p < .001), which increased to 47% in the sustainment phase. When repeat cultures were warranted (e.g., Staphylococcus aureus), the interval between cultures increased from 1.7 to 2.0 days (p = .002); during the sustainment phase it decreased to 1.9 days. We estimate that 1968 cultures would be averted yearly if the interventions were sustained.

Conclusions

During a culture bottle shortage, diagnostic stewardship interventions significantly decreased the proportion of unnecessary repeat cultures, thereby improving adherence to evidence-based care and reducing cost and environmental impact. After the shortage ended, the gains in stewardship were partially lost. This suggests that beyond improving education, interventions aimed at impressing upon providers the severity of the shortage itself impacted behavior. Future efforts should identify how positive behavior changes can be extended beyond acute crises to promote high-value, environmentally responsible healthcare.