The impact of electronic health record based decision tool in reducing clostridium Defficile testing

From the 2019 HVPAA National Conference

Dr. Faisal Fa’ak (Piedmont Athens Regional Medicine Center), Ms. Heather Alexander (Piedmont Athens Regional Medicine Center), Ms. Mckenna Brown (Piedmont Athens Regional Medicine Center), Dr. Roger Lovell (Piedmont Athens Regional Medicine Center), Mr. Scott Brown (Piedmont Athens Regional Medicine Center)

Background

Clostridium difficile infection (CDI) is a common community and healthcare-acquired infection associated with high mortality and morbidity rates. Studies have shown over-diagnosis and treatment as a result for inappropriately testing patients who have low pretest probability for infection.

Objectives

We aimed to reduce the number of patients inappropriately tested for CDI during their hospitalization

Methods

At a 350-bed hospital, we developed a computerized clinical decision support tool for Clostridium difficile testing. Upon ordering, Electronic health record (EHR) displays a series of question to the ordering provider: whether the patient has >3 unformed/watery stools in the past 24 hours; on laxative, kayexalate, lactulose, recent oral contrast; currently receiving treatment for CDI or tested for CDI in the past seven days. Also, the order includes the following statement “Patient must have clinically significant diarrhea and not b on laxatives or have a recent diagnosis of CDI.” The provider can order the test regardless of the responses. Also, providers were educated regarding the new testing guidelines. We performed a retrospective analysis for the rates of C. difficile test ordering six months before and after the implementation of the EHR tool.

Results

A total of 52,569 and 49,085 patient days were observed during the pre- and post-intervention periods, respectively. The EHR tool was associated with a 17.6 % reduction in the overall rate of C. difficile tests (170 tests per 10,000 patient days pre-intervention compared to 140 per 10,000 patient days post-intervention).

Conclusion

In this quality improvement project, EHR based question series targeting inappropriate C. difficile testing was associated with reduced rates of overall tests ordered.

Implication for the patients

This will correlate with appropriate testing, diagnosis, antibiotics use, reduced length of hospital stay, and eventually cost.

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