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To evaluate the impact of a hard stop in the electronic health record (EHR) on inappropriate gastrointestinal pathogen panel testing (GIPP).
We used a quasi-experimental study to evaluate testing before and after the implementation of an EHR alert to stop inappropriate GIPP ordering.
Midwest academic medical center.
Hospitalized patients with diarrhea for which GIPP testing was ordered, between January 2016 through March 2017 (period 1) and April 2017 through June 2018 (period 2).
A hard stop in the EHR prevented clinicians from ordering a GIPP more than once per admission or in patients hospitalized for >72 hours.
During period 1, 1,587 GIPP tests were ordered over 212,212 patient days, at a rate of 7.48 per 1,000 patient days. In period 2, 1,165 GIPP tests were ordered over 222,343 patient days, at a rate of 5.24 per 1,000 patient days. The Poisson model estimated a 30% reduction in total GIPP ordering rates between the 2 periods (relative risk, 0.70; 95% confidence interval [CI], 0.63–0.78; P < .001). The rate of inappropriate tests ordered decreased from 21.5% to 4.9% between the 2 periods (P < .001). The total savings calculated factoring only GIPP orders that triggered the hard stop was ∼$67,000, with potential savings of $168,000 when factoring silent best-practice alert data.
A simple hard stop alert in the EHR resulted in significant reduction of inappropriate GIPP testing, which was associated with significant cost savings. Clinicians can practice diagnostic stewardship by avoiding ordering this test more than once per admission or in patients hospitalized >72 hours.
Prior to World War II, Hawaiian music claimed enthusiastic audiences throughout the world. In some countries there were local performers of Hawaiian music who had never even visited the Islands. Although that popularity has greatly diminished, it is still surprisingly alive in such places as Japan, Indonesia, Canada, England, Holland, Sweden and elsewhere in Europe.1 Without exception, the most famous performers in these countries are masters of the Hawaiian steel guitar.2 In fact, the sound of the steel guitar is considered the hallmark of Hawaiian music.
Over a span of twenty-five years, I had the privilege of an extraordinary association with Charles Seeger. It began with an introduction by Jaap Kunst, in 1954, and ended with a letter dictated by Seeger and typed by his secretary (but still unsigned), a few days before his death in February, 1979. In our first meeting he was a teacher. In his last letter he was a warm concerned friend, and still a teacher. To say he is missed would be as redundant as saying one misses a brother, a father, a comrade-in-arms, a colleague, a best friend.
The surprise outcome of the 2016 presidential election continues to raise more questions as experts grapple with the evidence for why most prognosticators considered a Hillary Clinton victory almost certain. This article uses the 2016 Cooperative Congressional Election Study data to show that a primary explanation for why the election of Donald Trump was difficult to predict is that the bulk of his support did not materialize until Election Day, in the battleground states that he had to carry to win the Electoral College.