Background Blood cultures (BCs) are commonly performed in the emergency department (ED). Proper collection is paramount for accurate results, which includes obtaining at least two sets of BCs. In our EDs, an unacceptably high proportion of patients had solitary sets of BCs sent for analysis.

Objectives To reduce the rate of solitary sets of BCs being sent to the lab on patients discharged from the ED.

Methods Using PDSA cycles, we evaluated two sequential interventions. The first intervention included didactic educational sessions and reminders in ED staff huddles. The second intervention added a forcing function (FF) at the point of computer order entry that automatically printed sticker labels for two sets of BCs, instead of the previous default of one. Providers could still send single sets by discarding unused labels. The bi-weekly solitary BC rates were analyzed using statistical process control charts and segmented regression analyses.

Results The baseline rate of solitary BCs was 41.1%. The education intervention reduced this rate to 30.3%, and the FF reduced it further to 11.6% (total absolute reduction of 29.5% from baseline). With segmental regression analyses, education alone did not produce a statistically significant change when factoring time-related trends (P=0.071). However, the FF produced a statistically significant improvement (P<0.0005), which was sustained for 6 months.

Conclusions The combination of an education intervention and a computerized FF was more effective than education alone in reducing solitary BCs in our ED. FFs can be a powerful tool in modifying behaviours and processes in the clinical setting.⇓⇓⇓ ⇓

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Figure 4