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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
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).

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
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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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

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