Impact of Evidence-Based Guidelines on Outcomes of Hospitalized Patients With Clostridium difficile Infection
| Autor: | Wesley Prichard, Emily Cochard, Lindsay M. Saum, Brian Skinner, Ryan Medas, Stephen J. Knaus |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
0301 basic medicine
Male medicine.medical_specialty Evidence-based practice genetic structures 030106 microbiology Patient Readmission 03 medical and health sciences 0302 clinical medicine Health care Epidemiology medicine Humans 030212 general & internal medicine Intensive care medicine Hospitals Teaching Enterocolitis Pseudomembranous Aged Retrospective Studies Evidence-Based Medicine business.industry Clostridioides difficile Retrospective cohort study General Medicine Guideline Evidence-based medicine Clostridium difficile Length of Stay Middle Aged Hospital medicine Treatment Outcome Emergency medicine Practice Guidelines as Topic Female Guideline Adherence business |
| Zdroj: | Southern medical journal. 109(3) |
| ISSN: | 1541-8243 |
| Popis: | Objectives Clostridium difficile infection (CDI) is the most common healthcare-associated infection in the United States. Clinical practice guidelines for the treatment of CDI were updated in 2010 by the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America. An institutional guideline for the classification and management of CDI in accordance with the 2010 Society for Healthcare Epidemiology of America/Infectious Diseases Society of America guideline was developed and provided to attending physicians and medical residents in multiple formats. Methods We sought to determine the impact of an evidence-based guideline for the treatment of CDI at a community teaching hospital. A retrospective chart review was conducted to identify length of stay (LOS), readmission rates, direct cost, mortality, and physician adherence to guidelines in patients with International Classification of Diseases, Ninth Edition codes and laboratory confirmation of CDI between February 1, 2013 and January 31, 2014. Endpoints included LOS after diagnosis of CDI, 30-day readmission rates, direct cost after diagnosis of CDI, and mortality. Results A total of 351 patient encounters were included in the study. Although not statistically significant, it was found that guideline-based therapy (n = 131) was associated with a lower median LOS (6 days vs 8 days; P = 0.06). Thirty-day hospital readmission (25.2% vs 29.5%; P = 0.39) and median cost after diagnosis of CDI ($7238.48 vs $8794.81; P = 0.10) also were lower but not statistically significant. Patients with mild-to-moderate infection were found to have a significantly lower median LOS (5 days vs 7 days; P = 0.03) and median cost after diagnosis ($5257.85 vs $7680.56; P = 0.03) when treated with guideline-based therapy. Overall physician adherence to guidelines was low, at 38%. Conclusions Treatment with guideline-based therapy for CDI was associated with a trend toward a significantly lower LOS and cost. Barriers to physician adherence to guidelines still exist, despite education and guideline availability. Electronic health record-based order sets or clinical decision tools may improve recognition of and adherence to guidelines. |
| Databáze: | OpenAIRE |
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