Skip to main content Accessibility help
×
Home
Hostname: page-component-568f69f84b-56sbs Total loading time: 0.156 Render date: 2021-09-17T00:54:44.775Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Assessing the Efficacy and Unintended Consequences of Utilizing a Behavioral Approach to Reduce Inappropriate Clostridioides difficile Testing

Published online by Cambridge University Press:  02 November 2020

Lana Dbeibo
Affiliation:
Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine
Allison Brinkman
Affiliation:
Department of Infection Prevention, Indiana University Health
Cole Beeler
Affiliation:
Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine
Kristen Kelley
Affiliation:
Department of Infection Prevention, Indiana University Health
William Fadel
Affiliation:
Department of Biostatistics, Indiana University School of Medicine
Yun Wang
Affiliation:
Department of Infection Prevention, Indiana University Health
William Snyderman
Affiliation:
Department of Infection Prevention, Indiana University Health
Nicole Hatfield
Affiliation:
Department of Infection Prevention, Indiana University Health
Josh Sadowski
Affiliation:
Department of Infection Prevention, Indiana University Health Douglas Houston Webb, Department of Infection Prevention, Indiana University Health
Areeba Kara
Affiliation:
Department of Medicine, Indiana University School of Medicine
Rights & Permissions[Opens in a new window]

Abstract

HTML view is not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Background: Effective strategies to improve diagnostic stewardship around C. difficile infection (CDI) remain elusive. Electronic medical record-based solutions, such as ‘hard’ and ‘soft’ stops, have been associated with reductions in testing, but may not be sustainable due to alert fatigue. Additionally, data on the potential for undertesting, missed diagnoses, and the implications regarding patient harm or clusters of transmission are limited. In this study, we assessed the efficacy of a behavioral approach to diagnostic stewardship, while monitoring for unintended consequences. Methods: This quality improvement study was conducted January 2018–May 2019; baseline period: January–April 2018, implementation period: May–December 2018, sustainment period: January 2019–May 2019. First, we conducted an internal analysis and identified 3 barriers to appropriate testing: clinician’s perceived risk of CDI, inconsistent definition of diarrhea, and lack of involvement of nurses in diagnostic stewardship. A multidisciplinary team to address these barriers was then convened. The team utilized the Bristol stool scale to improve the reliability of diarrhea description, and created a guideline-concordant testing algorithm with clinicians and nurses. The primary outcome was the number of tests ordered. The secondary outcomes were the proportion of inappropriate tests and the proportion of delayed tests. Delayed tests were defined as CDI-compatible diarrhea based on the algorithm where the test was sent >24 hours after symptom onset. Results: During the baseline period, we detected no significant change in number of tests ordered month to month, with 194.2 tests ordered per month on average. During the postimplementation period, the number of tests ordered decreased by ~4.5 each month between January 2018 and May 2019 (P < .0001). The proportion of inappropriate tests steadily decreased from 54% to 30% across the 3 study periods, and the number of delayed testing changed from 11% to 1% then increased to 20% in the sustainment period. There were no cases of toxic megacolon associated with delayed testing. Conclusions: The decision to test for CDI is complex. Interventions that address this issue as a simple ‘right’ and ‘wrong’ fail to address the root cause of CDI overdiagnosis, and they have no embedded mechanism to detect unintended consequences. Our study demonstrates that by taking a behavioral approach and addressing clinicians’ safety concerns, we were able to sustain a significant reduction in testing. We could not determine the significance of the increase in delayed testing given the low numbers; however, further studies are needed to evaluate the safety of CDI reduction strategies through diagnostic stewardship only.

Funding: None

Disclosures: None

Type
Top Rated Posters Presentations
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.
You have Access

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Assessing the Efficacy and Unintended Consequences of Utilizing a Behavioral Approach to Reduce Inappropriate Clostridioides difficile Testing
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Assessing the Efficacy and Unintended Consequences of Utilizing a Behavioral Approach to Reduce Inappropriate Clostridioides difficile Testing
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Assessing the Efficacy and Unintended Consequences of Utilizing a Behavioral Approach to Reduce Inappropriate Clostridioides difficile Testing
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *