Decreased Mortality Associated With Prompt Gram Staining of Blood Cultures

Gram stains of positive blood cultures are the most important factor influencing appropriate therapy. The sooner appropriate therapy is initiated, the better. Therefore, it is reasonable to expect that the sooner Gram stains are performed, the better. To determine the value of timely Gram stains and whether improvement in Gram stain turnaround time (TAT) is feasible, we compared data for matched pairs of patients with cultures processed promptly (<1 hour TAT) with data for patients with cultures not processed promptly (≥1 hour TAT) and then monitored TAT by control charting. In 99 matched pairs, average difference in time to detection of positive blood cultures within a pair of patients was less than 0.1 hour. For the less than 1 hour TAT group, the average TAT and crude mortality were 0.1 hour and 10.1%, respectively; for the 1 hour or longer TAT group, they were 3.3 hours and 19.2%, respectively (P < .0001 and P = .0389, respectively). After multifaceted efforts, we achieved significant improvement in the TAT for Gram stains. The Institute of Medicine has recommended that medical practices become more patient-centered. 1 Two notable accomplishments are in the care of myocardial infarction and stroke. In patients with acute myocardial infarction, reduced door-to-balloon time for primary angioplasty decreases mortality. 2 Likewise, in the setting of stroke, studies suggest that