Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-06-01T04:46:23.627Z Has data issue: false hasContentIssue false
  • English
  • Français

The Impact of a Computerized Clinical Decision Support Tool on Inappropriate Clostridium difficile Testing

Published online by Cambridge University Press:  01 August 2017

Duncan R. White ,
Keith W. Hamilton ,
David A. Pegues ,
Asaf Hanish  and
Craig A. Umscheid
Duncan R. White
Affiliation:
Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Keith W. Hamilton
Affiliation:
Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
David A. Pegues
Affiliation:
Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Asaf Hanish
Affiliation:
Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
Craig A. Umscheid*
Affiliation:
Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania Institute for Biomedical Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania Institute for Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania
*
Address correspondence to Craig A. Umscheid, MD, MSCE, Penn Medicine, Perelman Center for Advanced Medicine, South Pavilion, 6th Floor, Office 623, 3400 Civic Center Boulevard, Philadelphia, PA 19104 (craig.umscheid@uphs.upenn.edu).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To evaluate the effectiveness of a computerized clinical decision support intervention aimed at reducing inappropriate Clostridium difficile testing

DESIGN

Retrospective cohort study

SETTING

University of Pennsylvania Health System, comprised of 3 large tertiary-care hospitals

PATIENTS

All adult patients admitted over a 2-year period

INTERVENTION

Providers were required to use an order set integrated into a commercial electronic health record to order C. difficile toxin testing. The order set identified patients who had received laxatives within the previous 36 hours and displayed a message asking providers to consider stopping laxatives and reassessing in 24 hours prior to ordering C. difficile testing. Providers had the option to continue or discontinue laxatives and to proceed with or forgo testing. The primary endpoint was the change in inappropriate C. difficile testing, as measured by the number of patients who had C. difficile testing ordered while receiving laxatives.

RESULTS

Compared to the 1-year baseline period, the intervention resulted in a decrease in the proportion of inappropriate C. difficile testing (29.6% vs 27.3%; P=.02). The intervention was associated with an increase in the number of patients who had laxatives discontinued and did not undergo C. difficile testing (5.8% vs 46.4%; P<.01) and who had their laxatives discontinued and underwent testing (5.4% vs 35.2%; P<.01). We observed a nonsignificant increase in the proportion of patients with C. difficile related complications (5.0% vs 8.9%; P=.11).

CONCLUSIONS

A C. difficile order set was successful in decreasing inappropriate C. difficile testing and improving the timely discontinuation of laxatives.

Infect Control Hosp Epidemiol 2017;38:1204–1208

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 10 , October 2017 , pp. 1204 - 1208
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATIONS: These data were presented as a poster at the Society of Hospital Medicine Annual Meeting on March 30, 2015, in National Harbor, Maryland, and at the 8th Annual Mid-Atlantic Healthcare Informatics Symposium, October 23, 2015, Philadelphia, Pennsylvania.

References

REFERENCES

1. Magill, SS, Hellinger, W, Cohen, J, et al. Prevalence of healthcare-associated infections in acute care hospitals in Jacksonville, Florida. Infect Control Hosp Epidemiol 2012;33:283–291.Google Scholar
2. Lee, GC, Reveles, KR, Attridge, RT, et al. Outpatient antibiotic prescribing in the United States: 2000 to 2010. BMC Medicine 2014;12:96.Google Scholar
3. McDonald, LC, Owings, M, Jernigan, DB. Clostridium difficile infection in patients discharged from US short-stay hospitals. EID 2006;12:409–415.Google ScholarPubMed
4. Dubberke, ER, Olsen, MA. Burden of Clostridium difficile on the healthcare system. Clin Infect Dis 2012;55:S88–S92.Google Scholar
5. Lessa, FC, Mu, Y, Bamberg, W, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:825–834.Google Scholar
6. Alasmari, F, Seiler, SM, Hink, T, Burnham, CD, Dubberke, ER. Prevelance and risk factor for asymptomatic Clostridium difficile carriage. Clin Infect Dis 2014;59:216–222.Google Scholar
7. Guerrero, DM, Becker, JC, Eckstein, EC, et al. Asymptomatic carriage of toxigenic Clostridium difficile by hospitalized patients. J Hosp Infect 2013;85:155–158.Google Scholar
8. Leekha, S, Aronhalt, KC, Sloan, LM, Patel, R, Orenstein, R. Asymptomatic Clostridium difficile colonization in a tertiary care hospital: admission prevalence and risk factors. Am J Infect Control 2013;41:390–393.CrossRefGoogle Scholar
9. Kelly, SG, Yarrington, M, Zembower, TR, et al. Inappropriate Clostridium difficile testing and consequent overtreatment and inaccurate publicly reported metrics. Infect Control Hosp Epidemiol 2016;37:1395–1400.CrossRefGoogle ScholarPubMed
10. Bartsch, SM, Umscheid, CA, Nachamkin, I, Hamilton, K, Lee, BY. Comparing the economic and health benefits of different approaches to diagnosing Clostridium difficile infection. Clin Microbiol Infect 2015;21(1):77.e1-9.Google Scholar
11. CDC/NHSN surveillance definitions for specific types of infections. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf. Published 2016. Accessed July 10, 2017.Google Scholar
12. Multidrug-resistant organism & Clostridium difficile infection (MDRO/CDI) Module. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/12pscMDRO_CDADcurrent.pdf. Published 2016. Accessed July 10, 2017.Google Scholar
13. Ziakas, PD, Zacharioudakis, IM, Zervou, FN, Grigora, C, Pliakos, EE, Mylonakis, E. Asymptomatic carriage of toxigenic C. difficile in long-term care facilities: a meta analysis of prevalence and risk factors. PLOS One 2015;10:e0117195.Google Scholar
Supplementary material: Image

White supplementary material

Figure S1

Download White supplementary material(Image)
Image 65.6 MB
Supplementary material: Image

White supplementary material

Figure S2

Download White supplementary material(Image)
Image 58.2 MB