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Diagnostic stewardship reduces C. difficile testing, saves money

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December 4, 2018

An automated pop-up screen in the electronic ordering system reduced unnecessary testing for Clostridioides difficile formerly called Clostridium difficile — infections and saved on overall costs, according to study findings published in Infection Control & Hospital Epidemiology.

Gregory R. Madden, MD, an infectious disease clinical fellow at the University of Virginia Medical Center, explained that the most common test used in hospitals to detect C. difficile — the nucleic acid amplification test — is unable to differentiate between infection and colonization in patients.

“As a result,” Madden told Infectious Disease News, “it is estimated that up to half of patients who test positive for C. difficile in the hospital may not actually require treatment, which ultimately leads to wasted health care dollars. One way to deal with this problem is to help clinicians know when is the right time to order the right test, and on the right patient. This approach is known as diagnostic stewardship.”

Madden and colleagues implemented a computerized clinical decision support (CCDS) tool at the University of Virginia Health System to reduce unnecessary testing and diagnostic errors after an internal audit revealed that up to 67% of hospital-onset C. difficile infection (HO-CDI) cases did not have an indication for C. difficile testing. Previously, their research showed that the CCDS reduced testing by 41%.

In a retrospective cost analysis, Madden and colleagues explored CCDS-related cost savings from reduced testing and fewer HO-CDI events, as well as the cost of building the tool and providing financial incentives to staff for improving C. difficile testing.

They estimated that the total laboratory cost — defined as materials and labor — was $31.36 per test. Additionally, the estimated attributable cost per hospitalized CDI case was between $3,669 and $9,197. Staff received a 0.8% financial incentive based on their salaries, according to the study. The researchers estimated a $1,000 cost associated with the technology used to create the CCDS tool, including developing the question algorithm and building and testing the software. All told, the cost analysis revealed a net annual savings of $61,524 related to the CCDS, largely due to the reductions in inpatient CDI treatment and laboratory diagnostics, Madden and colleagues said.

“Computer-aided diagnostic stewardship, in conjunction with education and institutional support, can significantly reduce unnecessary testing,” Madden said. “Fostering a thoughtful approach to testing can mean significant financial gains for the health care system.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.