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In pursuit of the holy grail: Improving C. difficile testing appropriateness with iterative electronic health record clinical decision support and targeted test restriction.

Publication ,  Journal Article
Karlovich, NS; Sata, SS; Griffith, B; Coop, A; Kalu, IC; Engemann, JJ; Seidelman, J; Turner, NA; Polage, CR; Smith, BA; Lewis, SS
Published in: Infect Control Hosp Epidemiol
July 2022

OBJECTIVE: To determine the impact of electronic health record (EHR)-based interventions and test restriction on Clostridioides difficile tests (CDTs) and hospital-onset C. difficile infection (HO-CDI). DESIGN: Quasi-experimental study in 3 hospitals. SETTING: 957-bed academic (hospital A), 354-bed (hospital B), and 175-bed (hospital C) academic-affiliated community hospitals. INTERVENTIONS: Three EHR-based interventions were sequentially implemented: (1) alert when ordering a CDT if laxatives administered within 24 hours (January 2018); (2) cancellation of CDT orders after 24 hours (October 2018); (3) contextual rule-driven order questions requiring justification when laxative administered or lack of EHR documentation of diarrhea (July 2019). In February 2019, hospital C implemented a gatekeeper intervention requiring approval for all CDTs after hospital day 3. The impact of the interventions on C. difficile testing and HO-CDI rates was estimated using an interrupted time-series analysis. RESULTS: C. difficile testing was already declining in the preintervention period (annual change in incidence rate [IR], 0.79; 95% CI, 0.72-0.87) and did not decrease further with the EHR interventions. The laxative alert was temporally associated with a trend reduction in HO-CDI (annual change in IR from baseline, 0.85; 95% CI, 0.75-0.96) at hospitals A and B. The gatekeeper intervention at hospital C was associated with level (IRR, 0.50; 95% CI, 0.42-0.60) and trend reductions in C. difficile testing (annual change in IR, 0.91; 95% CI, 0.85-0.98) and level (IRR 0.42; 95% CI, 0.22-0.81) and trend reductions in HO-CDI (annual change in IR, 0.68; 95% CI, 0.50-0.92) relative to the baseline period. CONCLUSIONS: Test restriction was more effective than EHR-based clinical decision support to reduce C. difficile testing in our 3-hospital system.

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Published In

Infect Control Hosp Epidemiol

DOI

EISSN

1559-6834

Publication Date

July 2022

Volume

43

Issue

7

Start / End Page

840 / 847

Location

United States

Related Subject Headings

  • Laxatives
  • Humans
  • Epidemiology
  • Electronic Health Records
  • Decision Support Systems, Clinical
  • Cross Infection
  • Clostridium Infections
  • Clostridioides difficile
  • 42 Health sciences
  • 32 Biomedical and clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Karlovich, N. S., Sata, S. S., Griffith, B., Coop, A., Kalu, I. C., Engemann, J. J., … Lewis, S. S. (2022). In pursuit of the holy grail: Improving C. difficile testing appropriateness with iterative electronic health record clinical decision support and targeted test restriction. Infect Control Hosp Epidemiol, 43(7), 840–847. https://doi.org/10.1017/ice.2021.228
Karlovich, Norah S., Suchita Shah Sata, Brian Griffith, Ashley Coop, Ibukunoluwa C. Kalu, John J. Engemann, Jessica Seidelman, et al. “In pursuit of the holy grail: Improving C. difficile testing appropriateness with iterative electronic health record clinical decision support and targeted test restriction.Infect Control Hosp Epidemiol 43, no. 7 (July 2022): 840–47. https://doi.org/10.1017/ice.2021.228.
Karlovich NS, Sata SS, Griffith B, Coop A, Kalu IC, Engemann JJ, et al. In pursuit of the holy grail: Improving C. difficile testing appropriateness with iterative electronic health record clinical decision support and targeted test restriction. Infect Control Hosp Epidemiol. 2022 Jul;43(7):840–7.
Karlovich, Norah S., et al. “In pursuit of the holy grail: Improving C. difficile testing appropriateness with iterative electronic health record clinical decision support and targeted test restriction.Infect Control Hosp Epidemiol, vol. 43, no. 7, July 2022, pp. 840–47. Pubmed, doi:10.1017/ice.2021.228.
Karlovich NS, Sata SS, Griffith B, Coop A, Kalu IC, Engemann JJ, Seidelman J, Turner NA, Polage CR, Smith BA, Lewis SS. In pursuit of the holy grail: Improving C. difficile testing appropriateness with iterative electronic health record clinical decision support and targeted test restriction. Infect Control Hosp Epidemiol. 2022 Jul;43(7):840–847.
Journal cover image

Published In

Infect Control Hosp Epidemiol

DOI

EISSN

1559-6834

Publication Date

July 2022

Volume

43

Issue

7

Start / End Page

840 / 847

Location

United States

Related Subject Headings

  • Laxatives
  • Humans
  • Epidemiology
  • Electronic Health Records
  • Decision Support Systems, Clinical
  • Cross Infection
  • Clostridium Infections
  • Clostridioides difficile
  • 42 Health sciences
  • 32 Biomedical and clinical sciences