BrighT STAR LIBRA: Leveraging Implementation Science for Blood Culture Reduction Approaches

Children's Hospital of Philadelphia (CHOP)

Status: Active, not recruiting

Conditions: Implementation Science; Antibiotic Stewardship; Blood Culture Rates

Treatments: Behavioral: Checklist; Behavioral: Targeted Messaging

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT06187662

5K23HL151381-03 (U.S. NIH Grant/Contract)

23-021013

Details and patient eligibility

About

This study will compare two strategies that target distinct determinants of blood culture overuse in an exploratory, hybrid, pilot trial in 8 PICUs. It aims to determine if there is any association between specific strategies used to reduce blood culture overuse on unit-wide blood culture rates, patient safety, and concurrently explore aspects of the implementation process (acceptability, feasibility, appropriateness).

Full description

Blood cultures are an important test to diagnose bacterial bloodstream infections, but can be ordered reflexively, excessively, and lead to downstream negative patient consequences such as unnecessary antibiotic exposure. Work to date has demonstrated safe and effective reduction in blood culture rates in the pediatric intensive care unit (PICU) setting, but optimal strategies to reduce culture use are currently unknown.

The primary study team will initially work with all enrolled sites in an identical fashion, facilitating a core series of steps for implementing a quality improvement blood culture diagnostic stewardship program which is identical to the steps used in the parent study, called BrighT STAR (Testing STewardship to reduce Antibiotic use and Resistance). In addition, the primary study team will randomize sites into two arms, in which different strategies are introduced that each target distinct determinants of blood culture overuse. The primary study team will examine the impact on blood culture rates, as well as evaluate aspects of the implementation process, in all sites pre- vs-post intervention.

Enrollment: 8 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Males or females over 18 years old
• PICU clinicians with direct patient care roles

Exclusion criteria

• Non-English speaking
• PICU clinicians who report to the investigator

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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8 participants in 2 patient groups

Default Bias

Experimental group

Description:

This intervention consists of a checklist to guide blood culture decisions, that a clinician in a site randomized to Arm A will be asked to consult and complete prior to ordering or not ordering a blood culture; as the relevant clinical scenario occurs.

Treatment:

Behavioral: Checklist

Loss Aversion

Experimental group

Description:

This intervention consists of targeted messaging and education that the primary study team will create and ask the Arm B sites to deliver to the PICU clinicians, which focuses on the importance of diagnostic stewardship and the current evidence for the benefit/low risk nature of the stewardship program to date. Sites in this arm will also receive a checklist to guide blood culture decisions, that clinicians at sites will be asked to consult and complete prior to ordering or not ordering a blood culture.

Treatment:

Behavioral: Targeted Messaging

Behavioral: Checklist