Use of Computerized Clinical Decision Support for Diagnostic Stewardship in Clostridioides difficile testing: an Academic Hospital Quasi-Experimental Study

Friedland, Anne E; Brown, Sara; Glick, D.R.; Lusby, Martha C.; Lemkin, Daniel L.; Leekha, Surbhi

doi:10.1007/s11606-018-4659-4

Cited by 13 publications

(7 citation statements)

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“…17 Multiple studies have found that a laxative alert alone may not dramatically reduce overall inappropriate C. difficile testing or improve CDI rates. 10,14 Providers at our hospitals overrode the laxative alert >70% of the time. Nevertheless, we observed a decrease in the number of laxative alerts as well as a decrease in the proportion of tests ordered on patients who had recently received laxatives over time, suggesting that clinicians learned to defer testing.…”

Section: Discussionmentioning

confidence: 99%

“…7 Multiple recent studies have demonstrated that clinical decision support incorporated into the electronic health record (EHR) can aid in reducing inappropriate C. difficile testing and overall hospitalonset CDI rate. [8][9][10][11][12][13][14] However, additional research has noted that clinicians often disregard such guidance and rely instead on clinical judgement and personal beliefs about CDI. 10,15,16 We implemented a series of clinical decision support interventions in the EHR from January 2018 to July 2019 with the goal of increasing appropriateness of C. difficile testing across our 3-hospital health system.…”

mentioning

confidence: 99%

“…[8][9][10][11][12][13][14] However, additional research has noted that clinicians often disregard such guidance and rely instead on clinical judgement and personal beliefs about CDI. 10,15,16 We implemented a series of clinical decision support interventions in the EHR from January 2018 to July 2019 with the goal of increasing appropriateness of C. difficile testing across our 3-hospital health system. The final EHR change was coupled with a laboratory policy to cancel tests when specified patient parameters were not met.…”

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confidence: 99%

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In pursuit of the holy grail: Improving C. difficile testing appropriateness with iterative electronic health record clinical decision support and targeted test restriction

Karlovich

Sata

Griffith

et al. 2021

Infect. Control Hosp. Epidemiol.

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Objective: To determine the impact of electronic health record (EHR)–based interventions and test restriction on Clostridioides difficile tests (CDTs) and hospital-onset C. difficile infection (HO-CDI). Design: Quasi-experimental study in 3 hospitals. Setting: 957-bed academic (hospital A), 354-bed (hospital B), and 175-bed (hospital C) academic-affiliated community hospitals. Interventions: Three EHR-based interventions were sequentially implemented: (1) alert when ordering a CDT if laxatives administered within 24 hours (January 2018); (2) cancellation of CDT orders after 24 hours (October 2018); (3) contextual rule-driven order questions requiring justification when laxative administered or lack of EHR documentation of diarrhea (July 2019). In February 2019, hospital C implemented a gatekeeper intervention requiring approval for all CDTs after hospital day 3. The impact of the interventions on C. difficile testing and HO-CDI rates was estimated using an interrupted time-series analysis. Results: C. difficile testing was already declining in the preintervention period (annual change in incidence rate [IR], 0.79; 95% CI, 0.72–0.87) and did not decrease further with the EHR interventions. The laxative alert was temporally associated with a trend reduction in HO-CDI (annual change in IR from baseline, 0.85; 95% CI, 0.75–0.96) at hospitals A and B. The gatekeeper intervention at hospital C was associated with level (IRR, 0.50; 95% CI, 0.42-0.60) and trend reductions in C. difficile testing (annual change in IR, 0.91; 95% CI, 0.85–0.98) and level (IRR 0.42; 95% CI, 0.22–0.81) and trend reductions in HO-CDI (annual change in IR, 0.68; 95% CI, 0.50–0.92) relative to the baseline period. Conclusions: Test restriction was more effective than EHR-based clinical decision support to reduce C. difficile testing in our 3-hospital system.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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In pursuit of the holy grail: Improving C. difficile testing appropriateness with iterative electronic health record clinical decision support and targeted test restriction

Karlovich

Sata

Griffith

et al. 2021

Infect. Control Hosp. Epidemiol.

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“…Thus, identification of high-burden facilities and tailoring interventions to facility-specific gaps are defining attributes of this targeted SPARC strategy. Because CDC TAP assessment tools and implementation guides for C. difficile prevention were still in development when SPARC launched, the SPARC team created its own tools de novo 13–22. SPARC developed assessment tools and resources to support QI efforts focused on four domains: infection prevention, environmental cleaning, antimicrobial stewardship and diagnostic stewardship.…”

Section: Methodsmentioning

confidence: 99%

“…Because CDC TAP assessment tools and implementation guides for C. difficile prevention were still in development when SPARC launched, the SPARC team created its own tools de novo. [13][14][15][16][17][18][19][20][21][22] SPARC developed assessment tools and resources to support QI efforts focused on four domains: infection prevention, environmental cleaning, antimicrobial stewardship and diagnostic stewardship. on December 21, 2021 by guest.…”

Section: Developmentmentioning

confidence: 99%

Impact of Statewide Prevention and Reduction of Clostridioides difficile (SPARC), a Maryland public health–academic collaborative: an evaluation of a quality improvement intervention

et al. 2021

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To evaluate changes in Clostridioides difficile incidence rates for Maryland hospitals that participated in the Statewide Prevention and Reduction of C. difficile (SPARC) collaborative. Pre-post, difference-in-difference analysis of non-randomised intervention using four quarters of preintervention and six quarters of postintervention National Healthcare Safety Network data for SPARC hospitals (April 2017 to March 2020) and 10 quarters for control hospitals (October 2017 to March 2020). Mixed-effects negative binomial models were used to assess changes over time. Process evaluation using hospital intervention implementation plans, assessments and interviews with staff at eight SPARC hospitals. Maryland, USA. All Maryland acute care hospitals; 12 intervention and 36 control hospitals. Participation in SPARC, a public health–academic collaborative made available to Maryland hospitals, with staggered enrolment between June 2018 and August 2019. Hospitals with higher C. difficile rates were recruited via email and phone. SPARC included assessments, feedback reports and ongoing technical assistance. Primary outcomes were C. difficile incidence rate measured as the quarterly number of C. difficile infections per 10 000 patient-days (outcome measure) and SPARC intervention hospitals’ experiences participating in the collaborative (process measures). SPARC invited 13 hospitals to participate in the intervention, with 92% (n=12) participating. The 36 hospitals that did not participate served as control hospitals. SPARC hospitals were associated with 45% greater C. difficile reduction as compared with control hospitals (incidence rate ratio=0.55, 95% CI 0.35 to 0.88, p=0.012). Key SPARC activities, including access to trusted external experts, technical assistance, multidisciplinary collaboration, an accountability structure, peer-to-peer learning opportunities and educational resources, were associated with hospitals reporting positive experiences with SPARC. SPARC intervention hospitals experienced 45% greater reduction in C. difficile rates than control hospitals. A public health–academic collaborative might help reduce C. difficile and other hospital-acquired infections in individual hospitals and at state or regional levels.

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The Role of Diagnostic Stewardship in Clostridioides difficile Testing: Challenges and Opportunities

Boly

Reske

Kwon

2020

Curr Infect Dis Rep

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Use of Computerized Clinical Decision Support for Diagnostic Stewardship in Clostridioides difficile testing: an Academic Hospital Quasi-Experimental Study

Cited by 13 publications

References 6 publications

In pursuit of the holy grail: Improving C. difficile testing appropriateness with iterative electronic health record clinical decision support and targeted test restriction

In pursuit of the holy grail: Improving C. difficile testing appropriateness with iterative electronic health record clinical decision support and targeted test restriction

Impact of Statewide Prevention and Reduction of Clostridioides difficile (SPARC), a Maryland public health–academic collaborative: an evaluation of a quality improvement intervention

The Role of Diagnostic Stewardship in Clostridioides difficile Testing: Challenges and Opportunities

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