Issue: To evaluate for possible intraabdominal fluid infection in pts with ascites, providers typically will send cell ct/diff and cultures (innoculated in aerobic/anaerobic blood culture bottles).  However, a positive culture representing true infection in the absence of the cell count revealing >250 PMNs is quite rare (often representing inadvertent contamination).  As the cell count is typically processed within a few hours, a provider will know the whether a pt meets cell count criteria for bacterial peritonitis: if it has <250 PMNs, this rules out infection in the vast majority of hospitalized pts and thus the pending cultures are clinically unnecessary (since they nearly always return negative) (recognizing there may be sub-populations where providers may still prefer to be conservative, esp in the immunocompromised or with atypical pathogens).

As we charge patients approx $200 *each* for aerobic and anerobic processing (as well as lab/staff/resource time), this represents a high-yield clinical situation to target waste. 

Idea: Work with the lab/micro and APEX to standardize a protocol of when to process the submitted culture bottles.  From a proceduralist work flow standpoint, providers can draw the necessary samples and submit to the lab, holding the culture bottles until further ntoice.  If the cell count returns "positive" (ie: >250PMNs), then Micro automatically processes the culture bottles. If the cell count does not, then the provider would have the option (either by automated page/in APEX somehow) to process or not (I would assume the most providers would select not). If there is no response from the provider, then the samples are automatically discarded within a certain time frame (ex: 24hrs).