Tool embedded in EHR improves C. difficile testing stewardship
A computerized clinical decision support tool safely improved Clostridioides difficile test stewardship at two facilities in Seattle, according to a study in Open Forum Infectious Diseases.
“We recognized that there was significant opportunity for improved diagnostic stewardship as it relates to C. difficile testing at our institution,” Catherine Liu, MD, associate professor of medicine at the University of Washington School of Medicine, told Healio. “We were interested in assessing whether a clinical decision support tool embedded in the [electronic health record] could improve appropriateness of C. difficile testing.”
Liu and colleagues compared C. difficile PCR test utilization, hospital-onset C. difficile infection (CDI) rates and clinical outcomes before and after the implementation of a computerized clinical decision support (CCDS) order at the University of Washington Medical Center (UWMC) and Harborview Medical Center (HMC).
According to the study, providers were automatically directed to use the electronic order set, which included guidelines that preferentially recommended testing patients with new-onset hospital-associated diarrhea in the absence of laxative use for C. difficile and prompted providers to order a multiplex enteric pathogen panel only for those presenting with community-onset diarrhea.
According to Liu, the study showed that the implementation of the CCDS reduced C. difficile PCR test utilization, specifically inappropriate testing in the setting of recent laxative use (HMC: –60.8%; 95% CI, –74.3%, –40.1%; UWMC: –37.3%; 95% CI, –58.2%, –5.9%). Compared with the 20-month preintervention period, the study showed that during a 12-month postimplementation period, there was an “immediate and sustained reduction” in PCR test utilization at both hospitals (HMC: –28.2%; 95% CI, –43.0%, –9.4%; UWMC: –27.4%; 95% CI, –37.5%, –15.6%), according to the study.
Researchers said the intervention was associated with an increase in the C. difficile test positivity rate at HMC (P = .01), although there were no significant differences in hospital-onset CDI rates or in the number of patients with hospital-onset CDI who developed severe CDI or CDI-associated complications.
“Computerized clinical decision support tools can be effective in directing clinicians toward appropriate C. difficile testing,” Liu concluded. “Although we did not observe any harm associated with more restrictive testing, we suggest that institutions adopting such tools also consider assessing for unintended adverse consequences.”