February 24, 2020
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Alert-based interventions reduce C. difficile testing, infection rates

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Abhishek Deshpande, MD, PhD 
Abhishek Deshpande
Aaron N. Dunn, BA 
Aaron N. Dunn

Clinical decision support tools, such as alert-based interventions for diagnostic stewardship, are associated with reductions in Clostridioides difficile testing and rates of C. difficile infection, or CDI, in hospitalized adults, a systematic review showed.

“We were motivated to conduct this study given the increasingly high burden of C. difficile infection among hospitalized patients and recent efforts by multiple hospitals to address this burden through innovations in electronic alert-based interventions,” Abhishek Deshpande, MD, PhD, of the Center for Value-Based Care Research, and Aaron N. Dunn, BA, of the Lerner College of Medicine of Case Western Reserve University, both at the Cleveland Clinic, told Healio. “While the goal of these electronic alerts is to discourage inappropriate testing and subsequent unnecessary antibiotic treatment, the impact of these tools had not been studied in detail.”

Deshpande, Dunn and colleagues performed a systematic review of 11 studies found through a search of Ovid MEDLINE and five other databases for studies evaluating the association between alerts related to CDI diagnostic stewardship and inappropriate CDI testing and CDI rates among hospitalized patients.

According to Deshpande and Dunn, the systematic review revealed that clinical decision support tools and alert-based interventions generally reduced overall C. difficile testing volume and, more importantly, reduced the volume of inappropriate tests. The researchers also found that there was significant heterogeneity and variations among interventions to reduce unnecessary C. difficile testing reported in the literature.

Deshpande and Dunn added that unintended adverse consequences and alert fatigue among providers are understudied, and further information regarding these outcomes of clinical decision support tools are necessary to fairly consider both the positive and potential negative impacts of these tools.

“The clinical take-home message is that clinical decision support tools aimed at curtailing inappropriate C. difficile testing appear to be largely successful at reducing testing volume, including inappropriate testing, which may lead to meaningful reductions in misdiagnosis and unnecessary treatment of patients colonized with C. difficile,” Deshpande and Dunn said. “However, caution must be taken when using such tools, as their negative impacts remain understudied.” – by Caitlyn Stulpin

Disclosures: Deshpande reports no relevant financial disclosures. Dunn reports receiving research funding and nonfinancial support from Clorox Healthcare and being on the advisory board of Ferring Pharmaceuticals. Please see the study for all other authors’ relevant financial disclosures.