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Test stewardship, frequency and fidelity: Impact on reported hospital-onset Clostridioides difficile

  • Michele S. Fleming (a1), Olivia Hess (a1), Heather L. Albert (a1), Emily Styslinger (a1), Michelle Doll (a1), Huong Jane Nguyen (a1), Susan McAulay-Kidd (a1), Robin R. Hemphill (a1), Tara Srivastava (a1), Kaila D. Cooper (a1), Michael P. Stevens (a1) and Gonzalo Bearman (a1)...


We assessed the impact of an embedded electronic medical record decision-support matrix (Cerner software system) for the reduction of hospital-onset Clostridioides difficile. A critical review of 3,124 patients highlighted excessive testing frequency in an academic medical center and demonstrated the impact of decision support following a testing fidelity algorithm.


Corresponding author

Author for correspondence: Michele S. Fleming, Email:


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1. Rock, C, Pana, Z, Leekha, S, et al. National healthcare safety network laboratory-identified Clostridium difficile event reporting: a need for diagnostic stewardship. Am J Infect Control 2018;46:456458.
2. Madden, G, Weinstein, R, Sifri, C. Diagnostic stewardship for healthcare-associated infections: opportunities and challenges to safely reduce test use. Infect Control Hosp Epidemiol 2018;39:214218.
3. Dubberke, E, Burnham, C. Diagnosis of Clostridium difficile infection treat the patient, not the test. JAMA Intern Med 2015;175:18011802.
4. Madden, G, Mesner, I, Cox, H, et al. Reduced Clostridium difficile tests and laboratory-identified events with a computerized clinical decision support tool and financial incentive. Infect Control Hosp Epidemiol 2018;39:737740.
5. Morgan, D, Malani, P, Diekema, D. Diagnostic stewardship: leveraging the laboratory to improve antimicrobial use. JAMA 2017;318:607608.
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Supplementary materials

Fleming et al. supplementary material
Fleming et al. supplementary material 1

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