In pursuit of the holy grail: Improving C. difficile testing appropriateness with iterative electronic health record clinical decision support and targeted test restriction
| Autor: | Norah S. Karlovich, Nicholas A Turner, Christopher R. Polage, Suchita Shah Sata, Ashley Coop, Sarah S. Lewis, Jessica Seidelman, John J. Engemann, Brian Griffith, Ibukunoluwa C. Kalu, Becky Smith |
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| Rok vydání: | 2021 |
| Předmět: |
Microbiology (medical)
medicine.medical_specialty Epidemiology business.industry Psychological intervention 030501 epidemiology C difficile Annual change Clinical decision support system Test (assessment) 03 medical and health sciences 0302 clinical medicine Infectious Diseases Electronic health record Emergency medicine medicine 030212 general & internal medicine 0305 other medical science business Clostridioides |
| Zdroj: | Infection Control & Hospital Epidemiology. 43:840-847 |
| ISSN: | 1559-6834 0899-823X |
| DOI: | 10.1017/ice.2021.228 |
| Popis: | Objective:To determine the impact of electronic health record (EHR)–based interventions and test restriction on Clostridioides difficile tests (CDTs) and hospital-onset C. difficile infection (HO-CDI).Design:Quasi-experimental study in 3 hospitals.Setting:957-bed academic (hospital A), 354-bed (hospital B), and 175-bed (hospital C) academic-affiliated community hospitals.Interventions:Three EHR-based interventions were sequentially implemented: (1) alert when ordering a CDT if laxatives administered within 24 hours (January 2018); (2) cancellation of CDT orders after 24 hours (October 2018); (3) contextual rule-driven order questions requiring justification when laxative administered or lack of EHR documentation of diarrhea (July 2019). In February 2019, hospital C implemented a gatekeeper intervention requiring approval for all CDTs after hospital day 3. The impact of the interventions on C. difficile testing and HO-CDI rates was estimated using an interrupted time-series analysis.Results:C. difficile testing was already declining in the preintervention period (annual change in incidence rate [IR], 0.79; 95% CI, 0.72–0.87) and did not decrease further with the EHR interventions. The laxative alert was temporally associated with a trend reduction in HO-CDI (annual change in IR from baseline, 0.85; 95% CI, 0.75–0.96) at hospitals A and B. The gatekeeper intervention at hospital C was associated with level (IRR, 0.50; 95% CI, 0.42-0.60) and trend reductions in C. difficile testing (annual change in IR, 0.91; 95% CI, 0.85–0.98) and level (IRR 0.42; 95% CI, 0.22–0.81) and trend reductions in HO-CDI (annual change in IR, 0.68; 95% CI, 0.50–0.92) relative to the baseline period.Conclusions:Test restriction was more effective than EHR-based clinical decision support to reduce C. difficile testing in our 3-hospital system. |
| Databáze: | OpenAIRE |
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