This article is especially important due to the advent of the surviving Sepsis campaigns. Early evaluation and treatment of sepsis has developed into protocols where blood cultures and lactate are obtained before the full clinical spectrum of the illness has been obtained.
Frequently we find that the patient has had blood cultures drawn, but subsequently the WBC does not support the diagnosis of Sepsis, or perhaps the patient has uncomplicated sepsis, and can be treated as an outpatient. The admission of all patients having had blood cultures drawn would be lead to untenable utilization of hospital beds, and untold illness of hospital acquired illnesses.
This admission of patients with blood cultures reflects the same unsupported dogma that a patient who receives parenteral antibiotics in the ED must be admitted.
Many blood cultured are ordered at triage as part of a triage protocol in order to meet (now antiquated) joint commission guidelines for pneumonia, etc. Often, full assessment of the patient indicates that bacteremia is unlikely, but the blood cultures have already been set up and the order is never removed (many EMR systems make deleting orders difficult.) On the other hand, no information was given about the liver function of this patient with history of Hepatitis C–patients with advanced liver disease are often immunocompromised.
Well, yeah.
We know blood cultures are useless most of the time and order them only because we’re mandated to so do.
When we know the patient is ill, we order them and admit.
Most blood cultures ordered over my signature are too satisfy a process measure, not to improve patient care.
5 Responses to “Should Emergency Department Patients with Pending Blood Cultures be Admitted?”
May 19, 2017
Christopher DarlingtonReally interesting read, thank you.
May 21, 2017
Robert J Halpern, MDThis article is especially important due to the advent of the surviving Sepsis campaigns. Early evaluation and treatment of sepsis has developed into protocols where blood cultures and lactate are obtained before the full clinical spectrum of the illness has been obtained.
Frequently we find that the patient has had blood cultures drawn, but subsequently the WBC does not support the diagnosis of Sepsis, or perhaps the patient has uncomplicated sepsis, and can be treated as an outpatient. The admission of all patients having had blood cultures drawn would be lead to untenable utilization of hospital beds, and untold illness of hospital acquired illnesses.
This admission of patients with blood cultures reflects the same unsupported dogma that a patient who receives parenteral antibiotics in the ED must be admitted.
May 21, 2017
Kathryn C. Peilen, MDMany blood cultured are ordered at triage as part of a triage protocol in order to meet (now antiquated) joint commission guidelines for pneumonia, etc. Often, full assessment of the patient indicates that bacteremia is unlikely, but the blood cultures have already been set up and the order is never removed (many EMR systems make deleting orders difficult.) On the other hand, no information was given about the liver function of this patient with history of Hepatitis C–patients with advanced liver disease are often immunocompromised.
May 21, 2017
Roderick FontenetteI guess the bigger question is why are we ordering blood cultures on patients we plan to discharge?
May 22, 2017
Tom BenzoniWell, yeah.
We know blood cultures are useless most of the time and order them only because we’re mandated to so do.
When we know the patient is ill, we order them and admit.
Most blood cultures ordered over my signature are too satisfy a process measure, not to improve patient care.