Solitary Blood Cultures

2001 ◽  
Vol 125 (10) ◽  
pp. 1290-1294
Author(s):  
David A. Novis ◽  
Jane C. Dale ◽  
Ron B. Schifman ◽  
Stephen G. Ruby ◽  
Molly K. Walsh
Keyword(s):  
Blood Culture ◽  
The United States ◽  
Blood Cultures ◽  
Private Institutions ◽  
Improvement Program ◽  
Institutional Practices ◽  
Public And Private ◽  
Control Programs ◽  
Practice Characteristics ◽  
Hospital Practices

Abstract Objective.—To determine the frequency with which solitary blood culture samples were submitted to laboratories serving small hospitals and to ascertain whether certain hospital practices relating to the performance of blood cultures were associated with lower solitary blood culture rates (SBCRs). Design.—Participants in the College of American Pathologists Q-Probes laboratory quality improvement program collected data prospectively on the numbers of solitary blood culture sets from adult patients submitted to their laboratories and answered questions about their institutions' practice characteristics relating to the collection of blood culture specimens. Setting and Participants.—Three hundred thirty-three public and private institutions with a median occupied bed size of 57. Participants were located in the United States (n = 329), Canada (n = 3), and Australia (n = 1). Main Outcome Measure.—The solitary blood culture rate was defined as the number of instances in which only 1 blood culture venipuncture was performed on an individual patient during a 24-hour period divided by the total number of blood culture venipunctures that were performed during the study period. Results.—Participants submitted data on 132 778 adult patient blood culture sets. The SBCRs were 3.4% or less in the top-performing 10% of participating institutions (90th percentile and above), 12.7% in the midrange of participating institutions (50th percentile), and 42.5% or more in the bottom-performing 10% of participating institutions (10th percentile and below). In half the participating institutions, the SBCRs for inpatients were 8.3% or less and for outpatients, 22% or less. Solitary blood culture rates were lower for institutions in which phlebotomists rather than nonphlebotomists routinely collected blood culture specimens, in which internal policies required drawing at least 2 blood culture sets, in which hospital personnel contacted clinicians when their laboratories received requests for solitary blood culture sets, and in which quality control programs monitored SBCRs routinely. Conclusions.—Hospitals can achieve SBCRs under 5%. Those hospitals with particularly high SBCRs may lower their rates by altering certain institutional practices.

Type and Screen Completion for Scheduled Surgical Procedures

2003 ◽  
Vol 127 (5) ◽  
pp. 533-540 ◽  
Author(s):  
Richard C. Friedberg ◽  
Bruce A. Jones ◽  
Molly K. Walsh
Keyword(s):  
The United States ◽  
Private Institutions ◽  
Improvement Program ◽  
Public And Private ◽  
Specific Protocol ◽  
Positive Antibody ◽  
Compromise Patient Safety ◽  
Clinically Significant ◽  
Surgery Delay ◽  
Time Type

Abstract Context.—Market-driven changes in the timing of elective surgeries and admissions have introduced barriers to completing pretransfusion testing in a timely manner. Consequently, blood bank personnel may not have adequate time to identify appropriate blood products for scheduled surgeries. Incomplete pretransfusion testing can delay surgery and significantly compromise patient safety. Objectives.—To identify the incidence of avoidable problems associated with obtaining timely samples for adequate pretransfusion type and screen (T&S) testing, to identify the practices and characteristics associated with improved rates of pretransfusion testing completed prior to surgery, and to determine the likelihood of antibody identification problems that affect the availability of blood. Design.—Participants in the College of American Pathologists (CAP) Q-Probes laboratory quality improvement program were asked to collect data on when a T&S was collected in anticipation of elective scheduled surgery, when the T&S was completed, when the surgery started, and the results of those T&S tests. Participants also completed questionnaires describing their facilities, procedures, and practices. Setting and Participants.—One hundred eight public and private institutions participated in this Q-Probes Study, 97% of which were located in the United States. Main Outcome Measures.—Type and screen collection and completion relative to the start of surgery, and the results of those tests. Results.—Of the 8941 T&Ss, 64.6% were collected prior to the day of surgery. The median laboratory completed approximately 69% of their T&S testing for scheduled surgeries at least 1 day prior to the surgery. Of those T&S tests that were collected on the day of surgery, the median laboratory completed almost 23% after the start of surgery. For 10% of participants, more than 75% of all T&Ss collected on the same day as surgery were not complete until after the start of surgery. When red blood cell–directed antibodies were identified, 78.7% were considered clinically significant, and 95.2% were alloantibodies. Positive antibody screens were significantly associated with delayed surgery and special efforts needed to obtain blood. Of those institutions with a specific protocol in place to collect T&S samples prior to hospital admission, the median laboratory completed the T&S at least 1 day prior to surgery 74% of the time. When the institution coupled the T&S collection protocol with T&S collection earlier than 3 days prior to surgery, the median laboratory completed the T&S at least 1 day prior to surgery almost 87% of the time. Type and screen collection less than 3 days prior to surgery resulted in special efforts needed to obtain blood more than 1% of the time. Type and screen collected on the same day as surgery directly resulted in a surgery delay 0.8% of the time. Conclusions.—Patients are unnecessarily being placed at risk by inadequate mechanisms to ensure available blood for surgery. All T&Ss were collected for scheduled surgeries with adequate opportunity for a T&S to be completed in advance of the surgery. Specific protocols helped improve the performance in terms of completing the T&S prior to surgery, as did mechanisms that permitted T&S collections in advance of the admission. Type and screen collection time relative to surgery was significantly associated with the incidence of surgery delay due to unavailable blood; the less time between collection and surgery, the less likely blood was available.

Morning Rounds Inpatient Test Availability

2000 ◽  
Vol 124 (4) ◽  
pp. 499-503 ◽  
Author(s):  
David A. Novis ◽  
Jane C. Dale
Keyword(s):  
The United States ◽  
Early Morning ◽  
Physician Satisfaction ◽  
Test Results ◽  
Improvement Program ◽  
Public And Private ◽  
Laboratory Service ◽  
Practice Characteristics ◽  
Laboratory Services ◽  
Laboratory Test Results

Abstract Objectives.—To determine the success with which laboratories were able to report morning test results on time, the laboratory practice characteristics associated with improved success, and the degree of satisfaction among clinicians with the timeliness of laboratory service. Design.—Hospital laboratories participating in the College of American Pathologist Q-Probes laboratory quality improvement program prospectively calculated the percentages of morning-run complete blood cell count (CBC) and electrolyte results that were reported on or before predetermined reporting deadlines, completed questionnaires concerning their departments' practice characteristics as they related to performing morning blood work, and distributed to physician utilizers of morning laboratory services questionnaires evaluating physician satisfaction with laboratory services. Setting and Participants.—A total of 367 public and private institutions located in the United States (355), Canada (5), Australia (2), and 1 each in the United Kingdom, Spain, Brazil, Korea, and Guam. Main Outcome Measure.—The percentages of morning-run CBC and electrolyte results reported on or before predetermined reporting deadlines. Results.—Participants submitted data on 40 256 CBC and 39 604 electrolyte specimens. In aggregate, a total of 88.9% of these tests (90.2% of CBCs and 87.6% of electrolytes) were reported on or before the reporting deadlines that the participating laboratories set for themselves. Half of the participants reported 94.6% of their CBC results and 95.5% of their electrolyte results on or before their self-imposed reporting deadlines. No specific demographic features or departmental practice characteristics were associated with higher or lower rates of institutional reporting compliance. Most physician utilizers of early-morning laboratory test results believed that the laboratory is sensitive to and meets the needs of clinicians for timely reporting of early-morning test results. Conclusions.—Most laboratories are capable of reporting 95% of their routine morning laboratory tests on time, and most physicians are satisfied with their laboratories' morning testing service.

Quality Indicators of Fresh Frozen Plasma and Platelet Utilization

2002 ◽  
Vol 126 (5) ◽  
pp. 527-532 ◽  
Author(s):  
David A. Novis ◽  
Stephen Renner ◽  
Richard C. Friedberg ◽  
Molly K. Walsh ◽  
Andrew J. Saladino
Keyword(s):  
United States ◽  
Quality Indicators ◽  
The United States ◽  
Fresh Frozen Plasma ◽  
Blood Bank ◽  
Private Institutions ◽  
Improvement Program ◽  
Public And Private ◽  
Fresh Frozen ◽  
Frozen Plasma

Abstract Objective.—To determine the normative rates of expiration and wastage for units of fresh frozen plasma (FFP) and platelets (PLTs) in hospital communities throughout the United States, and to examine hospital blood bank practices associated with more desirable (lower) rates. Design.—In 3 separate studies, participants in the College of American Pathologists Q-Probes laboratory quality improvement program collected data retrospectively on the numbers of units of FFP and PLTs that expired (outdated) prior to being used and that were wasted due to mishandling. Participants also completed questionnaires describing their hospitals' and blood banks' laboratory and transfusion practices. Setting and Participants.—One thousand six hundred thirty-nine public and private institutions, more than 80% of which were known to be located in the United States. Main Outcome Measures.—Quality indicators of FFP and PLT utilization: the rates of expiration and wastage of units of FFP and PLTs. Results.—Participants submitted data on 8 981 796 units of FFP and PLTs. In all 3 studies, aggregate combined FFP and PLT expiration rates ranged from 5.8% to 6.4% and aggregate combined FFP and PLT wastage rates ranged from 2.0% to 2.5%. Among the top-performing 10% of participants (90th percentile and above), FFP and PLT expiration rates were 0.6% or lower and FFP and PLT wastage rates were 0.5% or lower. Among the bottom-performing 10% of participants (10th percentile and below), expiration rates were 13.8% or higher and wastage rates were 6.8% or higher. We were unable to associate selected hospital characteristics or blood bank practices with lower rates of FFP and PLT utilization. Conclusions.—The rates of FFP and PLT expiration and wastage vary greatly among hospitals in the United States. Hospital blood bank personnel are capable of achieving FFP and PLT expiration and wastage rates below 1%.

scholarly journals Wastewater Surveillance for SARS-CoV-2 on College Campuses: Initial Efforts, Lessons Learned, and Research Needs

2021 ◽  
Vol 18 (9) ◽  
pp. 4455
Author(s):  
Sasha Harris-Lovett ◽  
Kara L. Nelson ◽  
Paloma Beamer ◽  
Heather N. Bischel ◽  
Aaron Bivins ◽  
...  
Keyword(s):  
Information Needs ◽  
Community Dynamics ◽  
The United States ◽  
Lessons Learned ◽  
Future Research ◽  
Private Institutions ◽  
Community Members ◽  
Public And Private ◽  
College And University ◽  
University Systems

Wastewater surveillance for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging approach to help identify the risk of a coronavirus disease (COVID-19) outbreak. This tool can contribute to public health surveillance at both community (wastewater treatment system) and institutional (e.g., colleges, prisons, and nursing homes) scales. This paper explores the successes, challenges, and lessons learned from initial wastewater surveillance efforts at colleges and university systems to inform future research, development and implementation. We present the experiences of 25 college and university systems in the United States that monitored campus wastewater for SARS-CoV-2 during the fall 2020 academic period. We describe the broad range of approaches, findings, resources, and impacts from these initial efforts. These institutions range in size, social and political geographies, and include both public and private institutions. Our analysis suggests that wastewater monitoring at colleges requires consideration of local information needs, sewage infrastructure, resources for sampling and analysis, college and community dynamics, approaches to interpretation and communication of results, and follow-up actions. Most colleges reported that a learning process of experimentation, evaluation, and adaptation was key to progress. This process requires ongoing collaboration among diverse stakeholders including decision-makers, researchers, faculty, facilities staff, students, and community members.

scholarly journals 847. The Effect of Antimicrobial Administration on Blood Culture Positivity in Patients with Severe Manifestations of Sepsis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S15-S16
Author(s):  
Matthew P Cheng ◽  
Robert Stenstrom ◽  
Katryn Paquette ◽  
Sarah Stabler ◽  
Murtaza Akhter ◽  
...  
Keyword(s):  
Blood Culture ◽  
Antimicrobial Therapy ◽  
Diagnostic Yield ◽  
The United States ◽  
Blood Cultures ◽  
Microbial Pathogens ◽  
Absolute Difference ◽  
Recovery Rates ◽  
Pathogen Recovery ◽  
Antimicrobial Administration

Abstract Background Current guidelines recommend obtaining blood cultures prior to antimicrobial therapy in patients with sepsis. Administering antimicrobials immediately without waiting for blood cultures could potentially decrease time to treatment and improve outcomes, but it is unclear the degree to which this strategy impacts diagnostic yield. Methods We performed a patient-level, single-arm, diagnostic trial. Seven urban emergency departments affiliated with academic medical centers across Canada and the United States participated in the study. Adults ≥18 years of age presenting to the emergency department with evidence of severe manifestations of sepsis, including a systolic blood pressure <90 mmHg and/or a serum lactate ≥4 mmol/L were included. Study participants had 2 sets of blood cultures drawn prior to and immediately following antimicrobial administration. The primary outcome was the difference in blood culture pathogen recovery rates before and after administration of antimicrobial therapy. Results Of the 3,164 participants screened, 325 were included in the study (mean age, 65.6 years; 63.0% men) and had repeat blood cultures drawn after the initiation of antimicrobial therapy (median time of 70 minutes, IQR 50 to 110 minutes). Pre-antimicrobial blood cultures were positive for one or more microbial pathogens in 102/325 (31.4%) patients. Fifty-four participants (52.9%) had matching blood culture results after initiation of antimicrobial treatment. The absolute difference in pathogen recovery rates was 14.5% ([95% CI 8.0 to 21.0%]; P < 0.0001) between pre- and post-antimicrobial blood cultures. Results were consistent in an analysis of the per-protocol population (absolute difference, 13.3% [95% CI 6.1 to 20.4%]; P < 0.0001). Including the results of other microbiological cultures done as part of routine care, microbial pathogens were recovered in 69 of 102 (67.7%) participants (absolute difference, 10.2% [95% CI 3.4 to 16.8%]; P < 0.0001). Conclusion Among patients with severe manifestations of sepsis, the administration of empiric antimicrobial therapy significantly reduces the yield of pathogen recovery when blood cultures are drawn shortly after treatment initiation. Disclosures All Authors: No reported Disclosures.

Tackling the Emerging New Norms in Higher Education in Post-Recession America

2017 ◽  
pp. 46-62
Author(s):  
Wayne Perry Webster ◽  
Zach P. Messitte
Keyword(s):  
Higher Education ◽  
The United States ◽  
Private Higher Education ◽  
Private Institutions ◽  
Prospective Students ◽  
Public And Private ◽  
Cost Structures ◽  
Education Leaders ◽  
Higher Education Leaders ◽  
New Situation

This chapter will examine emerging new norms across higher education in the United States following the recession of 2008-09. Colleges and universities face an environment increasingly made up of prospective students and their families shopping and bargaining for the best college deal; institutions are struggling to control student costs by raising discount rates; administrators are seeking to find new sources of revenue and programmatic niches; and faculty are increasingly focused on how to make their curriculum more unique and relevant. Finally, higher education leaders should closely examine long-held recruitment and financial aid strategies, cost structures, academic calendars and mission to meet the new situation. This chapter will summarize the development of the new landscape in public and private higher education, including the growing similarities facing public and private institutions including their common efforts to keep higher education affordable and accessible, and conclude with recommendations for administrators as they navigate their way through the new norm.

Specimen Collection Volumes for Laboratory Tests

2003 ◽  
Vol 127 (2) ◽  
pp. 162-168 ◽  
Author(s):  
Jane C. Dale ◽  
Stephen G. Ruby
Keyword(s):  
Blood Cell ◽  
Laboratory Tests ◽  
Private Institutions ◽  
Routine Laboratory ◽  
Improvement Program ◽  
Public And Private ◽  
Cell Counts ◽  
Clinical Laboratories ◽  
Blood Cell Counts ◽  
Specimen Collection

Abstract Context.—Unnecessary tests, inefficient ordering practices, and collection of more blood than is required for testing contribute to iatrogenic anemia in hospitalized patients. Laboratories accredited by the College of American Pathologists are expected to review phlebotomy practices for specimen collection volumes periodically. Objective.—To report specimen collection, analytic, and discard volumes for routine laboratory tests and to identify practice variables associated with overcollection and blood wastage. Design.—Clinical laboratories participating in the College of American Pathologists Q-Probes laboratory improvement program recorded collection container size, laboratory-defined requested volume, manufacturer-defined analytic volume, and average discard volume for routine complete blood cell counts and electrolyte panels ordered for patients in intensive care units. Participants provided information about their specimen collection, processing, and analytic practices in a questionnaire. Setting and Participants.—A total of 140 public and private institutions. Main Outcome Measures.—Overcollections for routine collections and for situations in which a reduced volume of specimen is collected, and average discard volume per tube. Results.—Laboratories collected a median of 2.76 mL (or 8.5 times) more than their instrument's analytic volume for routine complete blood cell counts and 1.75 mL (or 12 times) more than their instrument's analytic volume for routine electrolyte panels. For clinical situations in which reduced collection volumes were necessary, overcollection for the same analytes was 0.5 mL (3 times) and 0.44 mL (4.2 times), respectively. The median discard volume was 2.8 mL/tube for complete blood cell counts and 2.0 mL/tube for electrolyte panels. Specimen collection container size was directly associated with overcollections and discard volumes. Instrument analytic volume was not a determinant of blood wastage. Conclusions.—Most laboratories can decrease collection volumes without compromising the ability of the laboratory to report a reliable and timely result. Use of smaller collection tubes can help reduce blood wastage.

Documenting a Crisis: How Postsecondary Institutions Addressed DACA Students after Trump's Rescission

2019 ◽  
Vol 121 (5) ◽  
pp. 1-28
Author(s):  
Z. W. Taylor ◽  
Myra C. Barrera
Keyword(s):  
Higher Education ◽  
Crisis Communication ◽  
Reading Ability ◽  
The United States ◽  
Reading Level ◽  
Postsecondary Students ◽  
Institutions Of Higher Education ◽  
Private Institutions ◽  
Public And Private ◽  
Executive Leaders

Background/Context On September 5, 2017, U.S. President Donald Trump ordered an end to former President Barack Obama's 2012 immigration policy of Deferred Action for Childhood Arrivals (DACA), placing some 800,000 undocumented immigrants—including thousands of postsecondary students—in danger of deportation. Mere hours after President Trump's announcement, postsecondary leaders across the United States began releasing official statements in support of DACA. Aside from a postsecondary institution's extolling of core values, it is important to investigate how these official institutional statements addressed the most critical, at-risk constituency on their college campus: DACA students themselves. Purpose The purpose of this study was to analyze post-DACA rescission statements made by executive leaders of U.S. institutions of higher education to learn whether these statements addressed the most important audience of these statements—DACA students—and whether institutions of higher education provided these students the resources they needed in their time of crisis. Research Design The data were collected from each institution of higher education's website from September 5 to September 7, 2017. The sample included 218 official institutional (two-and four-year, public and private) statements made by executive leaders at these institutions. Data analysis included deductive attribute coding and quantitative content analysis techniques such as average word count and grade-level readability measures. Findings The post-DACA rescission statements greatly varied in length (longest = 1,118 words; shortest = 50 words) and were unreadable by postsecondary students of average reading ability, as the average statement was written above the 15th-grade reading level. Only 54% of all statements addressed DACA students, with negligible variance (0.5%) between public and private institutions. Only 51.9% of all statements provided resources for DACA students. Of those statements, 99.1% of resources were institution-provided, whereas 20.4% were community-provided, with private institutions (12.9%) offering more community-provided resources than public institutions (7.5%). Conclusions Institutions of higher education may want to consider best practices when composing crisis communication, primarily that crisis communication should focus on addressing the populations most affected by the crisis. Once the crisis communication is composed, that communication could be audited for its readability by the intended audience. Moreover, institutions of higher education may learn from the Virginia Tech massacre and apply it to their crisis management and communication strategies, namely by providing both institution-based and community-based resources to those most affected by the crisis. Finally, institutions of higher education may consider differentiating their crisis communication across multiple platforms such as social media, email, text message, and their institutional website to ensure that all stakeholders are aware of the potential solutions and resolutions to the crisis, in order to avoid miscommunication and a lack of organizational transparency while maintaining organizational integrity and honesty.

scholarly journals Streptobacillus moniliformis mitral valve endocarditis and septic arthritis: the challenges of diagnosing rat-bite fever endocarditis

2018 ◽  
Vol 10 (2) ◽  
Author(s):  
Daisy Torres-Miranda ◽  
Madhi Moshgriz ◽  
Marc Siegel
Keyword(s):  
United States ◽  
Mitral Valve ◽  
Blood Culture ◽  
The United States ◽  
Blood Cultures ◽  
Native Valve ◽  
Native Valve Endocarditis ◽  
Streptobacillus Moniliformis ◽  
Rat Bite Fever ◽  
Mitral Valve Vegetation

Streptobacillus moniliformis, the cause of rat-bite fever (RBF) in the United States, has rarely been reported as a cause of infectious endocarditis. In the majority of previously reported cases, the diagnosis was clinically based in patients with underlying valvular abnormalities in the setting of positive blood culture for Streptobacillus moniliformis. We report a case of native valve endocarditis secondary to Streptobacillus moniliformis in a woman with a mitral valve vegetation but negative blood cultures where the diagnosis was established using molecular diagnostics on the valvular tissue.

Publicness

2017 ◽  
Vol 49 (4) ◽  
pp. 471-490 ◽  
Author(s):  
Charles T. Goodsell
Keyword(s):  
United States ◽  
The United States ◽  
Private Institutions ◽  
Public And Private ◽  
The Public ◽  
Responsibility Of Government

The Publicness discussed here exists when the society as a whole is working hard on behalf of its hungry and unsafe. Such work is not the responsibility of government alone but its private institutions as well. When studied closely, one finds in the United States a remarkably diverse and interpenetrated array of antipoverty activity across the public and private arenas. Its totality is regarded as an aggregate and identifiable yet scarcely recognized realm of pan-society activity named Publicness. Whether its present extent is sufficient is most doubtful.

Sign in / Sign up

Export Citation Format

Share Document