Work system assessment to facilitate the dissemination of a quality improvement program for optimizing blood culture use: A case study using a human factors engineering approach

Background. Work system assessments can facilitate successful implementation of quality improvement programs. Using a human factors engineering approach, we conducted a work system assessment to facilitate the dissemination of a quality improvement program for optimizing blood culture use in pediatric intensive care units at 2 hospitals. Methods. Semistructured face-to-face interviews were conducted with clinicians from Johns Hopkins All Children’s Hospital and University of Virginia Medical Center. Interview data were analyzed using qualitative content analysis. Results. Blood culture–ordering practices are influenced by various work system factors, including people, tasks, tools and technologies, the physical environment, organizational conditions, and the external environment. A clinical decision-support tool could facilitate implementation by (1) standardizing blood culture–ordering practices, (2) ensuring that prescribing clinicians review the patient’s condition before ordering a blood culture, (3) facilitating critical thinking, and (4) empowering nurses to communicate with physicians and advocate for adherence to blood culture–ordering guidelines. Conclusion. The success of interventions for optimizing blood culture use relies heavily on the local context. A work system analysis using a human factors engineering approach can identify key areas to be addressed for the successful dissemination of quality improvement interventions.