Table 4.

Example Strategies to Target Determinants of Blood Culture Overuse

Determinant of Culture Overuse	Potential Strategy Targeted to that Determinant
Reflexive testing as normative practice (default bias)	Timely bedside huddle to evaluate patient’s clinical status before ordering cultures
Perception of blood cultures as low-risk test (individual characteristics)	Education for providers about negative consequences of unnecessary testing and antibiotic resistance
Influence of non-PICU clinicians on culture decisions (inner setting)	Collaborative development of guideline or algorithm about blood cultures, including when cultures may be deferred, to ensure all stakeholder perspectives are represented
External sepsis guidelines (outer setting)	Inclusion in time-to-antibiotic algorithms of rapid specific review of patient’s risk factors for bacteremia and level of concern for bacterial infection, before orders for cultures and antibiotics