Aims In neonates treated for suspected early onset infection, NICE guidance recommends discontinuing antibiotics at 36 h in clinically well patients with negative blood cultures.
A local audit confirmed that delay in blood culture reporting resulted in 56% of babies needlessly continuing on antibiotics, with negative implications for both the family (mother/infant separation, impact on breast feeding, unnecessary investigations) and the provider (logistical and financial).
We aimed to identify the root cause contributing to the delays in blood culture processing and reporting, and introduce key interventions that would facilitate early discharge, thereby enhancing the quality and safety of care provided, and improve family experience.
Method Using cause and effect analysis, we identified root causes and barriers to blood culture processing and reporting. We then process mapped the journey of a blood culture, from decision to treat to the time the final culture result was available. We then randomly selected patients with suspected early onset neonatal sepsis over a one month period (20 babies), and audited the time taken for each stage of the blood culture journey, to allow interventions to be focused appropriately (Figure 1).
Results The mean time for blood culture results to be reported was 59 h (range 50–79 h), with the longest delays occurring at laboratory level. This was due to a 10-hour delay in processing of samples taken out of hours. The results demonstrate that 100% of babies audited were unnecessarily continued on intravenous antibiotics, significantly delaying their discharge (Figure 2).
Conclusion In collaboration with local microbiology colleagues, several changes were introduced: blood culture reporting protocols have changed from 48 to 36 h, cultures are now processed out of hours and investment in a satellite blood culture analyser on the neonatal unit is being considered. These changes are expected to result in a cost savings of £53,152 per annum based on 0.7 bed days saved/mother-infant pair.
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