Charlotte Z Woods-Hill, Danielle W Koontz, Anping Xie, Elizabeth A Colantuoni, Anna Sick-Samuels, Marlene R Miller, Abigail Arthur, Anushree Aneja, Urmi Kumar, Aaron M Milstone
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We now examine the implementation process in detail to understand how sites facilitated this diagnostic stewardship program in their PICUs.</p><p><strong>Design: </strong>A multi-center electronic survey of the 14 BrighT STAR sites, based on qualitative data about the implementation process collected during the primary phase of BrighT STAR.</p><p><strong>Setting: </strong>14 PICUs enrolled in BrighT STAR.</p><p><strong>Participants: </strong>Site leads at each enrolled site.</p><p><strong>Methods: </strong>An electronic survey guided by implementation science literature and based on data collected during BrighT STAR was administered to all 14 sites after completion of the primary phase of the collaborative.</p><p><strong>Results: </strong>10 specific tasks appear critical to implementing blood culture diagnostic stewardship, with variability in site-level strategies employed to accomplish those tasks. Sites rated certain tasks and strategies as highly important. Strategies used in top-performing sites were distinct from those used in lower-performing sites. Certain strategies may link to drivers of culture overuse and represent key targets for changing clinician behavior.</p><p><strong>Conclusions: </strong>BrighT STAR offers important insights into the tasks and strategies used to facilitate successful diagnostic stewardship in the PICU. More work is needed to compare specific strategies and optimize stewardship outcomes in this complex environment.</p><p><strong>Clinical trial registry information: </strong>Blood Culture Improvement Guidelines and Diagnostic Stewardship for Antibiotic Reduction in Critically Ill Children (Bright STAR). 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We now examine the implementation process in detail to understand how sites facilitated this diagnostic stewardship program in their PICUs.</p><p><strong>Design: </strong>A multi-center electronic survey of the 14 BrighT STAR sites, based on qualitative data about the implementation process collected during the primary phase of BrighT STAR.</p><p><strong>Setting: </strong>14 PICUs enrolled in BrighT STAR.</p><p><strong>Participants: </strong>Site leads at each enrolled site.</p><p><strong>Methods: </strong>An electronic survey guided by implementation science literature and based on data collected during BrighT STAR was administered to all 14 sites after completion of the primary phase of the collaborative.</p><p><strong>Results: </strong>10 specific tasks appear critical to implementing blood culture diagnostic stewardship, with variability in site-level strategies employed to accomplish those tasks. Sites rated certain tasks and strategies as highly important. 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引用次数: 0
摘要
目的：BrighT STAR是由全美14个儿科重症监护病房（PICU）组成的诊断管理合作项目，旨在规范和减少不必要的血液培养，并研究其对患者预后和广谱抗生素使用的影响。现在，我们详细研究了该计划的实施过程，以了解各医疗机构是如何在其 PICU 中推动这一诊断监管计划的：设计：根据在 BrighT STAR 初级阶段收集的有关实施过程的定性数据，对 14 个 BrighT STAR 机构进行多中心电子调查：14 个加入 BrighT STAR 的 PICU：方法：在实施科学理论指导下进行电子调查：方法：以实施科学文献为指导，以 BrighT STAR 期间收集的数据为基础，在合作的初级阶段结束后，对所有 14 个站点进行电子调查：结果：10 项具体任务似乎对实施血液培养诊断监管至关重要，而为完成这些任务所采用的研究机构策略则各不相同。研究机构认为某些任务和策略非常重要。表现最佳的研究机构所采用的策略与表现较差的研究机构所采用的策略截然不同。某些策略可能与文化过度使用的驱动因素有关，是改变临床医生行为的关键目标：BrighT STAR为PICU成功开展诊断管理的任务和策略提供了重要启示。在这种复杂的环境中，还需要做更多的工作来比较具体策略和优化管理结果：临床试验登记信息：血培养改进指南和诊断管理以减少重症儿童使用抗生素（Bright STAR）。NCT03441126。https://www.clinicaltrials.gov/study/NCT03441126?term=Bright%20STAR&aggFilters=status:com&checkSpell=false&rank=1。
Diagnostic stewardship for blood cultures in the pediatric intensive care unit: lessons in implementation from the BrighT STAR Collaborative.
Objective: BrighT STAR was a diagnostic stewardship collaborative of 14 pediatric intensive care units (PICUs) across the United States designed to standardize and reduce unnecessary blood cultures and study the impact on patient outcomes and broad-spectrum antibiotic use. We now examine the implementation process in detail to understand how sites facilitated this diagnostic stewardship program in their PICUs.
Design: A multi-center electronic survey of the 14 BrighT STAR sites, based on qualitative data about the implementation process collected during the primary phase of BrighT STAR.
Setting: 14 PICUs enrolled in BrighT STAR.
Participants: Site leads at each enrolled site.
Methods: An electronic survey guided by implementation science literature and based on data collected during BrighT STAR was administered to all 14 sites after completion of the primary phase of the collaborative.
Results: 10 specific tasks appear critical to implementing blood culture diagnostic stewardship, with variability in site-level strategies employed to accomplish those tasks. Sites rated certain tasks and strategies as highly important. Strategies used in top-performing sites were distinct from those used in lower-performing sites. Certain strategies may link to drivers of culture overuse and represent key targets for changing clinician behavior.
Conclusions: BrighT STAR offers important insights into the tasks and strategies used to facilitate successful diagnostic stewardship in the PICU. More work is needed to compare specific strategies and optimize stewardship outcomes in this complex environment.
Clinical trial registry information: Blood Culture Improvement Guidelines and Diagnostic Stewardship for Antibiotic Reduction in Critically Ill Children (Bright STAR). NCT03441126. https://www.clinicaltrials.gov/study/NCT03441126?term=Bright%20STAR&aggFilters=status:com&checkSpell=false&rank=1.
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