A Retrospective Evaluation of Critical Care Blood Culture Yield - Do Support Services Contribute to the "Weekend Effect"?

PLoS One 2015 22;10(10):e0141361. Epub 2015 Oct 22.

Department of Clinical Sciences, Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpoool, United Kingdom; Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom.

Background: The "weekend effect" describes an increase in adverse outcomes for patients admitted at the weekend. Critical care units have moved to higher intensity working patterns to address this with some improved outcomes. However, support services have persisted with traditional working patterns. Blood cultures are an essential diagnostic tool for patients with sepsis but yield is dependent on sampling technique and processing. We therefore used blood culture yield as a surrogate for the quality of support service provision. We hypothesized that blood culture yields would be lower over the weekend as a consequence of reduced support services.

Methods: We performed a retrospective observational study examining 1575 blood culture samples in a university hospital critical care unit over a one-year period.

Results: Patients with positive cultures had, on average, higher APACHE II scores (p = 0.015), longer durations of stay (p = 0.03), required more renal replacement therapy (p<0.001) and had higher mortality (p = 0.024). Blood culture yield decreased with repeated sampling with an increased proportion of contaminants. Blood cultures were 26.7% less likely to be positive if taken at the weekend (p = 0.0402). This effect size is the equivalent to the impact of sampling before and after antibiotic administration.

Conclusions: Our study demonstrates that blood culture yield is lower at the weekend. This is likely caused by delays or errors in incubation and processing, reflecting the reduced provision of support services at the weekend. Reorganization of services to address the "weekend effect" should acknowledge the interdependent nature of healthcare service delivery.

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Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0141361PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4619625PMC
June 2016
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