Dataset Information

Improving Appropriate Diagnosis of Clostridioides difficile Infection Through an Enteric Pathogen Order Set With Computerized Clinical Decision Support: An Interrupted Time Series Analysis.

ABSTRACT:

Background

Inappropriate testing for Clostridioides difficile leads to overdiagnosis of C difficile infection (CDI). We determined the effect of a computerized clinical decision support (CCDS) order set on C difficile polymerase chain reaction (PCR) test utilization and clinical outcomes.

Methods

This study is an interrupted time series analysis comparing C difficile PCR test utilization, hospital-onset CDI (HO-CDI) rates, and clinical outcomes before and after implementation of a CCDS order set at 2 academic medical centers: University of Washington Medical Center (UWMC) and Harborview Medical Center (HMC).

Results

Compared with the 20-month preintervention period, during the 12-month postimplementation of the CCDS order set, there was an immediate and sustained reduction in C difficile PCR test utilization rates at both hospitals (HMC, -28.2% [95% confidence interval {CI}, -43.0% to -9.4%], P?=?.005; UWMC, -27.4%, [95% CI, -37.5% to -15.6%], P?C difficile tests ordered in the setting of laxatives (HMC, -60.8% [95% CI, -74.3% to -40.1%], P?P?=?.02). The intervention was associated with an increase in the C difficile test positivity rate at HMC (P?=?.01). There were no significant differences in HO-CDI rates or in the proportion of patients with HO-CDI who developed severe CDI or CDI-associated complications including intensive care unit transfer, extended length of stay, 30-day mortality, and toxic megacolon.

Conclusions

Computerized clinical decision support tools can improve C difficile diagnostic test stewardship without causing harm. Additional studies are needed to identify key elements of CCDS tools to further optimize C difficile testing and assess their effect on adverse clinical outcomes.

SUBMITTER: Liu C

PROVIDER: S-EPMC7566360 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Publications

Improving Appropriate Diagnosis of <i>Clostridioides difficile</i> Infection Through an Enteric Pathogen Order Set With Computerized Clinical Decision Support: An Interrupted Time Series Analysis.

Liu Catherine C Lan Kristine K Krantz Elizabeth M EM Kim H Nina HN Zier Jacqlynn J Bryson-Cahn Chloe C Chan Jeannie D JD Jain Rupali R Lynch John B JB Pergam Steven A SA Pottinger Paul S PS Sweet Ania A Whimbey Estella E Bryan Andrew A

Open forum infectious diseases 20200821 10

<h4>Background</h4>Inappropriate testing for <i>Clostridioides difficile</i> leads to overdiagnosis of <i>C difficile</i> infection (CDI). We determined the effect of a computerized clinical decision support (CCDS) order set on <i>C difficile</i> polymerase chain reaction (PCR) test utilization and clinical outcomes.<h4>Methods</h4>This study is an interrupted time series analysis comparing <i>C difficile</i> PCR test utilization, hospital-onset CDI (HO-CDI) rates, and clinical outcomes before a ...[more]

PMID: 33094113

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