Problem: Bloodstream infections (BSI) are common and cause severe disease and death. Blood cultures are used to identify whether patients have a bacterial or fungal BSI and assess whether the microbe will be resistant to any antimicrobial therapies (AMTs). This can help clinicians to prescribe AMTs to patients who truly need them, using targeted treatment where possible. NHS England’s blood culture audit indicated low adherence to best practice guidelines, with substantial regional variations. Trusts have raised concerns regarding the economic and resource implications of achieving guideline compliance.
Approach: Aquarius conducted a pragmatic economic evaluation, working closely with NHS England and NHS microbiologists to understand current practice, and the consequences of guideline compliance, in the pre-analytic phase of the blood culture pathway. A simple decision tree model was adapted from a previously published economic model to evaluate the economic and clinical benefits of achieving guideline compliance. This included using adequate blood culture volumes and keeping collection-to-load time under 4 hours.
Impact: Our work provides NHS England with empirical evidence demonstrating that guideline compliance is associated with better patient outcomes and may also be cost-saving for Trusts.