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Improving Appropriate Utilization of Procalcitonin in Critically Ill Medical Patients FREE TO VIEW

Anisha Arora*, MD; Elena Laserna, MD; Kelly Echevarria, PharmD; Antonio Anzueto, MD; Gregory Smith, DDS; Jose Cadena, MD; Amruta Parekh, MD; Oriol Sibila, MD; Marcos Restrepo, MD
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UTHSCSA, San Antonio, TX

Chest. 2012;142(4_MeetingAbstracts):364A. doi:10.1378/chest.1388157
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SESSION TYPE: ICU Safety and Improvement Strategies

PRESENTED ON: Tuesday, October 23, 2012 at 02:45 PM - 04:15 PM

PURPOSE: Procalcitonin (PCT) use is associated with the reduction of antibiotic prescription and/or duration of antimicrobial therapy. Inappropriate PCT utilization may waste resources, particularly in high risk critically ill patients, if the results do not change management and care. Our aim was to develop a quality improvement program that would increase knowledge of appropriate use and improve appropriate utilization of PCT by 50% in critically ill patients admitted to a medical intensive care unit (MICU).

METHODS: A pre- and post- quality improvement implementation program was evaluated in a cohort of critically ill patients admitted to the MICU. The pre-QI implementation review included PCT tests performed from April 1, 2011 to June 30, 2011 (14 weeks). The QI intervention included an educational program, development and implementation of an algorithm for PCT utilization and post-clinical performance data. Post-QI implementation review included PCT samples collected from January 11, 2012 to February 16, 2012 (6 weeks). The primary education outcome was increase in knowledge after an educational activity involving clinical cases regarding appropriate PCT use to internal medicine students, residents, pulmonary and critical care fellows. In addition, clinical outcome evaluated the appropriate PCT testing based on evidence-based medicine recommendations, according to an adjudication committee. Chi-square and Student s t-test were used to compare categorical and continuous variables, respectively.

RESULTS: During the pre-QI period there were 477 PCT collected samples, of which 164 (34.4%) were obtained from the MICU. In the post-QI period 182 PCT tests were ordered, including 58 (31.9%) obtained in the MICU. Knowledge of appropriate PCT use increased from 50% in the pre-test evaluation vs. 84% in the post-test evaluation period (p<0.001). In addition, the appropriate PCT utilization improved from 35.4% in the pre-QI project period to 74% in the post-QI intervention period (p<0.0001).

CONCLUSIONS: After implementing a multi-faceted QI program, procalcitonin utilization was improved in critically ill patients admitted to the MICU.

CLINICAL IMPLICATIONS: Further QI studies are needed to assess the clinical effectiveness of other important clinical parameters in critically ill patients requiring ICU admission.

DISCLOSURE: The following authors have nothing to disclose: Anisha Arora, Elena Laserna, Kelly Echevarria, Antonio Anzueto, Gregory Smith, Jose Cadena, Amruta Parekh, Oriol Sibila, Marcos Restrepo

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UTHSCSA, San Antonio, TX




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