Contaminant blood cultures and resource utilization: the true consequences of false-positive results

Article Abstract:

Physicians often order cultures of patients' blood to rule out the possibility of septicemia (a bloodborne, systemic bacterial infection), a dangerous condition. However, a significant proportion of cultures give positive results due to contamination (a false-positive result), not because the patient actually has septicemia. This can lead to the unnecessary use of antibiotics, additional tests, and longer hospital stays. To determine the costs of false-positive blood cultures, a study was carried out of all cases at one medical facility for which blood cultures were obtained during a period of several months. A blood culture episode was defined as any 48-hour period beginning when the blood to be tested was obtained. Patient charts were reviewed the day the episode began or next morning to obtain clinical and laboratory data. These consisted of approximately 200 variables related to hospitalization and any diseases or conditions additional to the one being treated. Patient diseases were classified as rapidly fatal (predicted fatality within one month); ultimately fatal (within five years); or nonfatal. Information concerning resource utilization (length of stay, total charges, tests, and services used during hospital stay) was obtained. Positive blood cultures were classified as true positives (with definite presence of contaminants) or equivocal. Results for 1,191 episodes involving 94 contaminants showed that altered mental status, age, presence of an intravascular device (for instance, a venous catheter), an underlying disease, or a major additional disease, were associated with false-positive results. Such episodes were associated with increased charges for intravenous antibiotics (39 percent higher) and microbiology testing (80 percent higher) as compared with negative episodes; a trend toward longer hospital stays was also noted. The average total charge for patients with false-positive results was $13,116 compared with $8,731 for patients with negative results. Technical difficulties in obtaining a sterile blood samples in certain cases are discussed. These results illustrate the increased cost of false-negative cultures, and suggest that it may be desirable to avoid culturing patients at low risk for septicemia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Causes of, Diagnostic errors, Medical care, Cost of, Health care costs, Microbial contamination, Blood chemical analysis, Septicemia, blood

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The academic health care system: preserving the missions as the paradigm shifts

Article Abstract:

Academic medical centers must recognize and respond to the changes that are reshaping the US health care system. In the medical marketplace of the 1990s, insurers rely on cost controls to remain competitive. Incentives to limit costs reward hospitals and clinicians for decreasing the use of medical services, thereby promoting efficiency. These pressures weigh heaviest on academic institutions by limiting access to care needed by the poorest and sickest patients. Academic medical centers must respond to these changes by building health care systems, increasing primary care, and competing for managed care contracts. As managed care decreases hospitalization rates, academic health centers must secure larger contracts from other primary care providers or build large health care networks in order to maintain the inpatient population necessary for teaching and research.

Influence, Health care reform, Hospitals, University, University hospitals, Hospital administration

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Translating good advice into better practice

Article Abstract:

Physicians may be more likely to adopt clinical practice guidelines if they have a say in their development and can provide feedback on their usefulness. Practice guidelines are documents that summarize the most effective way of diagnosing or treating specific medical conditions. Many doctors do not like to be told how to treat patients and may resent this intrusion into their practice. Practice guidelines should be carefully developed and thoroughly tested. They should be simple to follow and should still allow physicians to use their own judgment.

Editorial, Analysis, Practice guidelines (Medicine), Medical protocols

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