Objective: To evaluate solitary blood culture (SBC) collections as a preanalytic quality indicator of blood culture practice.
Design and setting: Two College of American Pathologists Q-Probes laboratory quality improvement studies involving prospective evaluation of the proportion of and reasons for SBC collections in 909 institutions.
Outcome: Reduction in the proportion of SBCs.
Results: Of 289572 blood culture sets studied, the median proportion of SBCs per institution was 10.1% and 12.1% among adult inpatients, 25.4% and 33.3% among adult outpatients, and 89.0% and 100% among pediatric/infant patients in the first and second (follow-up) studies, respectively. The two most common reasons for not performing a second culture in adults were (1) test not indicated and (2) physician believed one was sufficient. When compared with inpatient cultures, a significantly higher proportion of outpatient SBCs were classified as not indicated (P < .0001). Among 198 institutions participating in both studies, a significant decline in SBC rates was observed in the subgroup (n = 50) that continued to monitor SBCs (P = .004).
Conclusions: Interinstitutional evaluation of solitary blood cultures provides a benchmark for quality assessment and an opportunity for performance improvement in blood culture specimen collections.