Blood Culture Bottle Shortage: Reducing ED Utilization in One Health System

Jonathan Nover, MBA, RN
Vice President of Nursing | Emergency Services
Mount Sinai Health System, New York City

The problem.

In early July 2024, a nationwide blood culture bottle shortage was announced. At the Mount Sinai Health System, specifically for our eight emergency departments (ED), naturally high utilizers, it was critical to devise contingency plans to reduce utilization and preserve supplies. Since it was evident early on that ED nursing would play a critical role in reducing utilization and waste, it was crucial to understand our current burn rates, utilization rates, contamination rates, and fill volume rates. We would need to recalibrate our blood culture stewardship and check in with our teams to understand workflows and their knowledge baseline about the nationwide shortage.

Discovering a gap in knowledge.

Through varying methods including huddles; “walking the GEMBA” with nursing leaders, epidemiologists, and infection preventionists; and eliciting transparent feedback we learned very quickly that our ED teams were not all aware of the top reasons for blood culture waste.

A nursing practice alert.

We created a nursing practice alert to highlight several key elements we’d learned . The areas of focus,

2024-09-12T10:31:16-04:00September 3rd, 2024|Nursing|0 Comments
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Creating a Disaster Simulation for Nursing Students

A nursing student treats a volunteer acting as a disaster victim during a high-fidelity simulation at the University of South Carolina Aiken Convocation Center. Photo courtesy of the authors.

According to the National Oceanic and Atmospheric Administration (NOAA), in the United States “there were 28 weather and climate disasters in 2023, surpassing the previous record of 22 in 2020.” With the number of disasters increasing in recent years, preparedness is crucial.

Many simulationists may believe that creating a disaster simulation is complicated, expensive, and requires a lot of resources. The opposite is true if you have enough support from your organization and community. The only cost incurred during our disaster management simulation project for nursing students at our institution was the cost of make-up to create realistic wounds.

Finding a gap in student knowledge.

The first thing we did was to perform a needs assessment. We knew that our students were not well prepared in our program for caring for patients during a disaster. In the past, this area of content was never really addressed in our curriculum. As we were working […]

2024-04-08T12:03:27-04:00April 8th, 2024|disaster preparedness, Nursing, Nursing education, Public health, simulation|0 Comments
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One Hospital and Community’s Rock Garden of Hope

In March 2020, Mount Sinai Queens, like many other hospitals, was overrun with patients with COVID-19. Despite layers of PPE, plus anxiety, exhaustion, and communication overload, the will to not only survive but thrive sustained the breath behind every mask. Heroes of all types were saving and soothing lives, and still are.

Outside the big front door of our hospital is a bustling ED ramp. To the left were two 18-wheel refrigeration trucks, the sight of which could take your breath away. To the far right were two 30-foot inflatable enclosed tents propped up to help the ED off-load abundant overcrowding inside. These were constant reminders that we were living through a once-in-100-year-pandemic.

An ER nurse’s creative response to a grim time.

The health care workers at the hospital weren’t the only ones subjected to these grim sights; so were our Astoria neighbors, who lived on the same block facing the ED ramp. We’ve always prided ourselves on the collaborative work we do for and with this community, including health fairs, screenings, and partnering with them on community boards. So one of us, an ED nurse named Fionnuala Quiqley (Nuala), decided to do something about it.

Nuala is a skilled and passionate ED nurse with more than 14 years of experience. She is also […]

2022-12-08T10:19:25-05:00December 8th, 2022|COVID-19, Nursing|1 Comment
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‘Just’ a Backache: Red Flags for Serious Underlying Conditions

A common complaint in the ED.

Years ago, as an ED nurse, I saw many patients whose primary complaint was back pain. Most of these were from recent trauma, such as after the patient had sustained a fall or was involved in a motor vehicle accident or other injury-causing incident. In one dramatic case, a patient came in with sudden, severe back pain, not realizing he had been stabbed!

I remember a young man who came in on a Sunday, complaining of a backache that had developed over the prior few weeks. He assumed it was just a muscle strain from working out, but finally sought treatment because the pain wasn’t letting up and had spread to include pain and numbness down one leg. As it turns out, he had a badly herniated disc.

Emergency departments fill a care gap for many patients.

Today, patients come to EDs not just for emergencies or even “urgencies”—EDs are often the only place an individual may have access to care. For some patients with ongoing health problems, an ED is where they go when the pain or disability has finally become too much to bear.

What red flags should nurses look out for with back pain in the ED?

“[N]onspecific low back pain that does not resolve with self-care and prompts patients to seek treatment in an ED may result from a serious underlying pathology…”

This month’s CE article, “Assessing Back Pain in Patients Presenting to the ED” (free to […]

2021-07-08T10:55:16-04:00July 8th, 2021|Nursing|0 Comments
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AJN July Issue: Postpartum Depression, Red Flags for Back Pain in the ED, More

“The deeper into the swamp we walked, the greater the stillness. Negativity and angst dissolved. Silence seeped into our spines, relaxing our amplified neural conversations and untying cranky muscles.”—Pamela Sturtevant in her Reflections essay, “Of Swamps and Pandemics”

The July issue of AJN is now live. Here’s what’s new. Some articles may be free only to subscribers.

CE: Assessing Back Pain in Patients Presenting to the ED

This article describes the red flags that can alert clinicians to serious underlying conditions in patients who seek emergency care for back pain.

CE: Postpartum Depression: A Nurse’s Guide

The author presents the latest information on this debilitating mood disorder, including risk factors; consequences for the mother, partner, and baby; and screening and treatment options.

Legal Clinic: Crisis Standards of Care

The author discusses the ethical issues that arise when the standards of care shift from conventional to crisis and explains the legal implications for nurses. […]

2021-06-30T09:52:35-04:00June 30th, 2021|Nursing|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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