Blood Culture Reduction Approaches for Sepsis
(LIBRA Trial)
What You Need to Know Before You Apply
What is the purpose of this trial?
This trial explores ways to reduce unnecessary blood tests in pediatric intensive care units (PICUs). It tests two approaches: using a checklist to guide decisions and providing targeted messages to help doctors make informed choices. The goal is to determine if these methods can lower blood test rates without compromising patient safety. Clinicians in PICUs who deliver direct patient care and speak English may be suitable for this study. As an unphased trial, this study allows clinicians to contribute to improving patient care practices in PICUs.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications.
What prior data suggests that these strategies are safe for reducing blood culture overuse?
Past studies have shown that using tools like checklists and specific messages is safe. Checklists for treating sepsis proved to be safe and practical, although some studies couldn't fully confirm their effectiveness. Other research demonstrated that checklists reduced unnecessary blood tests by 25%.
For targeted messaging, studies found that these messages helped lower the number of blood tests ordered without causing harm. Educating doctors to order only necessary tests can improve patient care without added risk.
Both checklists and targeted messaging are generally well-received. They help hospital staff make better decisions without introducing new risks to patients.12345Why are researchers excited about this trial?
Researchers are excited about these trial interventions for sepsis because they focus on improving decision-making for blood cultures, a key diagnostic tool. The "Default Bias" arm uses a checklist to guide clinicians in deciding whether to order a blood culture, potentially reducing unnecessary tests and improving patient care. The "Loss Aversion" arm combines this checklist with targeted messaging and education, emphasizing the benefits and low risks of diagnostic stewardship. These approaches are unique because they aim to enhance clinical judgment and reduce overtesting, unlike current practices that often rely heavily on routine testing without such structured guidance.
What evidence suggests that this trial's strategies could be effective in reducing blood culture overuse in sepsis?
In this trial, participants will follow different approaches to improve blood culture decisions in sepsis care. One group will use a checklist to guide clinicians on when to take blood samples. Research shows this can make the process quicker and more efficient. Specifically, one study found that such tools ensured prompt blood sample collection when an infection was suspected. Another group will focus on targeted messaging and education, including educational messages to enhance diagnostic stewardship. A review of several studies found that alert systems for sepsis, often incorporating educational messages, helped doctors adhere to guidelines better and improved patient outcomes. These educational messages and reminders have made collecting blood samples faster and safer.46789
Who Is on the Research Team?
Charlotte Woods-Hill, MD
Principal Investigator
Children's Hospital of Philadelphia
Are You a Good Fit for This Trial?
This trial is for male or female clinicians over 18 years old who work in Pediatric Intensive Care Units (PICUs) and have direct patient care roles. It's not open to those who don't speak English or PICU clinicians reporting directly to the investigator.Inclusion Criteria
Exclusion Criteria
Timeline for a Trial Participant
Screening
Participants are screened for eligibility to participate in the trial
Implementation
Implementation of a quality improvement blood culture diagnostic stewardship program across all sites, followed by randomization into two arms with different strategies.
Evaluation
Evaluation of blood culture rates and implementation outcomes using surveys and qualitative interviews.
Follow-up
Participants are monitored for safety outcomes and effectiveness of the intervention post-implementation.
What Are the Treatments Tested in This Trial?
Interventions
- Checklist
- Targeted Messaging
Trial Overview
The study compares two strategies: a checklist and targeted messaging, aimed at reducing unnecessary blood culture tests in PICUs. It explores how these strategies affect test rates, patient safety, and evaluates their acceptability and feasibility.
How Is the Trial Designed?
2
Treatment groups
Experimental Treatment
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.
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.
Find a Clinic Near You
Who Is Running the Clinical Trial?
Children's Hospital of Philadelphia
Lead Sponsor
National Heart, Lung, and Blood Institute (NHLBI)
Collaborator
Johns Hopkins University
Collaborator
Published Research Related to This Trial
Citations
Clinical decision support improves blood culture collection ...
Our study demonstrates that a simple CDS intervention can improve timely blood culture collections when the concern for infection is high enough ...
Hospital Sepsis Program Core Elements
Sepsis outcomes metrics, such as mortality, ICU admission, and length of hospitalization, are important to understanding the outcomes of hospital sepsis ...
Effectiveness of multidisciplinary interventions to improve ...
A multidisciplinary collaborative model proves effective in improving blood culture efficiency and optimizing antimicrobial usage.
Data extraction forms for clinical effectiveness studies
Data are from the subset of checklists that reported insertion site (10850 of 11575 checklists; 93.7%).
Effectiveness of Multimodal Intervention to Improve Blood ...
Results. On analysis, the blood culture contamination rate in the pre-interventional phase dropped drastically from 6.16% to 3.03% in the post- ...
Sepsis Recognition - Making Healthcare Safer III - NCBI - NIH
The outcomes studied were mortality, ICU admissions rate, and ICU LOS. Attributing improvement in these outcomes to sepsis screening tools is difficult, however ...
Surviving sepsis campaign: international guidelines for ...
The results demonstrated that the intervention was feasible and safe, but the study was underpowered and therefore inconclusive regarding its clinical ...
Sepsis Program Activities in Acute Care Hospitals
In 2022, 73% of hospitals reported having a sepsis program, ranging from 53% among hospitals with 0–25 beds to 95% among hospitals with >500 beds.
Association of a Clinical Practice Guideline With Blood ...
After the intervention, there was an immediate 25.0% reduction in the rate of cultures per 100 patient-days (95% CI, 4.2%-39.7%; P = .02) and a ...
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