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The impact of an electronic medical record nudge on reducing testing for hospital-onset Clostridioides difficile infection

Published online by Cambridge University Press:  10 February 2020

Jessica R. Howard-Anderson*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Mary Elizabeth Sexton
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Chad Robichaux
Affiliation:
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Zanthia Wiley
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Jay B. Varkey
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Sujit Suchindran
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Benjamin Albrecht
Affiliation:
Department of Pharmacy, Emory Healthcare, Atlanta, Georgia
K. Ashley Jones
Affiliation:
Department of Pharmacy, Emory Healthcare, Atlanta, Georgia
Scott K. Fridkin
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Jesse T. Jacob
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
*
Author for correspondence: Jessica R. Howard-Anderson, E-mail: Jrhowa4@emory.edu

Abstract

Objective:

To determine the effect of an electronic medical record (EMR) nudge at reducing total and inappropriate orders testing for hospital-onset Clostridioides difficile infection (HO-CDI).

Design:

An interrupted time series analysis of HO-CDI orders 2 years before and 2 years after the implementation of an EMR intervention designed to reduce inappropriate HO-CDI testing. Orders for C. difficile testing were considered inappropriate if the patient had received a laxative or stool softener in the previous 24 hours.

Setting:

Four hospitals in an academic healthcare network.

Patients:

All patients with a C. difficile order after hospital day 3.

Intervention:

Orders for C. difficile testing in patients administered a laxative or stool softener in <24 hours triggered an EMR alert defaulting to cancellation of the order (“nudge”).

Results:

Of the 17,694 HO-CDI orders, 7% were inappropriate (8% prentervention vs 6% postintervention; P < .001). Monthly HO-CDI orders decreased by 21% postintervention (level-change rate ratio [RR], 0.79; 95% confidence interval [CI], 0.73–0.86), and the rate continued to decrease (postintervention trend change RR, 0.99; 95% CI, 0.98–1.00). The intervention was not associated with a level change in inappropriate HO-CDI orders (RR, 0.80; 95% CI, 0.61–1.05), but the postintervention inappropriate order rate decreased over time (RR, 0.95; 95% CI, 0.93–0.97).

Conclusion:

An EMR nudge to minimize inappropriate ordering for C. difficile was effective at reducing HO-CDI orders, and likely contributed to decreasing the inappropriate HO-CDI order rate after the intervention.

Type
Original Article
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

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Footnotes

PREVIOUS PRESENTATION: A preliminary version of this work was presented at the Society for Healthcare Epidemiology of America Spring Conference on April 26, 2019, in Boston, Massachusetts.

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