Quality assurance metrics and lean management interventions for reducing errors in high-volume hospital blood culture processing

Bloodstream infections remain a major cause of morbidity and mortality worldwide with blood cultures serving as the diagnostic gold standard. However, in high-volume hospital settings, the reliability of blood culture results is frequently compromised by pre-analytical and analytical errors including blood culture contamination. This narrative review synthesizes evidence published between 2020 and 2025 on quality assurance (QA) metrics and Lean management interventions aimed at reducing errors in high-throughput blood culture processing. Core QA indicators like contamination rates, blood volume adequacy and utilization rates are examined as foundational tools for monitoring performance and guiding improvement. The integration of these approaches creates a feedback loop whereby data-driven measurement informs systematic intervention and improvement outcomes against established benchmarks. Emerging technologies such as blood culture diversion devices, automated laboratory systems, and standardized collection kits, demonstrate promise in augmenting these efforts. Multimodal interventions combining standardized protocols with targeted staff training consistently reduced contamination rates across diverse clinical settings. Inadequate blood volume collection with mean volumes as low as 4.5 mL in some hematology wards significantly compromise diagnostic sensitivity. The review highlights the value of integrating QA metrics with Lean methodologies that support sustained quality improvement. Persistent gaps remain in long-term sustainability, economic evaluation, human factors research and standardization across healthcare systems. Addressing these gaps is essential to improving diagnostic accuracy, antimicrobial stewardship and healthcare efficiency.