Impact of an electronic smart order-set for diagnostic stewardship of Clostridiodes difficile infection (CDI) in a community healthcare system in South Florida
Inappropriate testing for Clostridiodes difficile infection (CDI) increases health care onset cases and contributes to overdiagnosis and overtreatment of patients in a community health care system. An electronic smart order set for the testing of CDI was created and implemented to improve the approp...
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| Veröffentlicht in: | American journal of infection control 2024-08, Vol.52 (8), p.893-899 |
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| container_title | American journal of infection control |
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| creator | Eckardt, Paula Guran, Rachel Jalal, Ayesha T. Krishnaswamy, Shiv Samuels, Shenae Canavan, Kelsi Martinez, Elsa A. Desai, Ajay Miller, Nancimae Cano Cevallos, Edison J. |
| description | Inappropriate testing for Clostridiodes difficile infection (CDI) increases health care onset cases and contributes to overdiagnosis and overtreatment of patients in a community health care system.
An electronic smart order set for the testing of CDI was created and implemented to improve the appropriateness of testing. A retrospective review of patients who were tested for CDI, pre and post, was conducted to determine if inappropriate stool testing for CDI decreased post-implementation of the order set.
224 patients were tested for CDI during the study period with the post-implementation period having a higher proportion of patients who met appropriate testing criteria defined by presence of diarrhea (80.5% vs 61.3%; P = .002). The rate of inappropriate CDI stool testing decreased from 31.1% to 11.0% after implementation (P |
| doi_str_mv | 10.1016/j.ajic.2024.04.181 |
| format | Article |
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An electronic smart order set for the testing of CDI was created and implemented to improve the appropriateness of testing. A retrospective review of patients who were tested for CDI, pre and post, was conducted to determine if inappropriate stool testing for CDI decreased post-implementation of the order set.
224 patients were tested for CDI during the study period with the post-implementation period having a higher proportion of patients who met appropriate testing criteria defined by presence of diarrhea (80.5% vs 61.3%; P = .002). The rate of inappropriate CDI stool testing decreased from 31.1% to 11.0% after implementation (P < .001). A higher proportion of CDI patients were readmitted within 30 days of discharge (54.2% vs 33.0%; P = 0.001) during the post-implementation period.
There was a significant reduction in inappropriate CDI testing following the implementation of the order set. There was an observed increase in the proportion of patients who underwent recent gastrointestinal surgery which may have contributed to the increase in 30-day readmission rates during the post-implementation period.
•Stewardship for CDI using an electronic smart orders reduced inappropriate testing in a retrospective pre and post-implementation study.•Rate of inappropriate testing decreased in post-implementation time period.•Increase in 30-day readmissions in the post-implementation period may be explained by patient outcomes like recent GI surgery.</description><identifier>ISSN: 0196-6553</identifier><identifier>ISSN: 1527-3296</identifier><identifier>EISSN: 1527-3296</identifier><identifier>DOI: 10.1016/j.ajic.2024.04.181</identifier><identifier>PMID: 38935020</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Clostridioides difficile - isolation & purification ; Clostridium Infections - diagnosis ; Community Health Services ; Diagnostic Tests, Routine ; Electronic health record ; Female ; Florida ; Humans ; Infection prevention and control ; Male ; Middle Aged ; Retrospective Studies ; Smart orders</subject><ispartof>American journal of infection control, 2024-08, Vol.52 (8), p.893-899</ispartof><rights>2024</rights><rights>Copyright © 2024. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c237t-6bbe253a79c61f9853f788f828594fca44d62899e1b3a4538b0883574f9cb6da3</cites><orcidid>0000-0003-0392-5861 ; 0000-0002-6798-6922 ; 0000-0002-8357-0628 ; 0000-0002-7281-6231</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ajic.2024.04.181$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38935020$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Eckardt, Paula</creatorcontrib><creatorcontrib>Guran, Rachel</creatorcontrib><creatorcontrib>Jalal, Ayesha T.</creatorcontrib><creatorcontrib>Krishnaswamy, Shiv</creatorcontrib><creatorcontrib>Samuels, Shenae</creatorcontrib><creatorcontrib>Canavan, Kelsi</creatorcontrib><creatorcontrib>Martinez, Elsa A.</creatorcontrib><creatorcontrib>Desai, Ajay</creatorcontrib><creatorcontrib>Miller, Nancimae</creatorcontrib><creatorcontrib>Cano Cevallos, Edison J.</creatorcontrib><title>Impact of an electronic smart order-set for diagnostic stewardship of Clostridiodes difficile infection (CDI) in a community healthcare system in South Florida</title><title>American journal of infection control</title><addtitle>Am J Infect Control</addtitle><description>Inappropriate testing for Clostridiodes difficile infection (CDI) increases health care onset cases and contributes to overdiagnosis and overtreatment of patients in a community health care system.
An electronic smart order set for the testing of CDI was created and implemented to improve the appropriateness of testing. A retrospective review of patients who were tested for CDI, pre and post, was conducted to determine if inappropriate stool testing for CDI decreased post-implementation of the order set.
224 patients were tested for CDI during the study period with the post-implementation period having a higher proportion of patients who met appropriate testing criteria defined by presence of diarrhea (80.5% vs 61.3%; P = .002). The rate of inappropriate CDI stool testing decreased from 31.1% to 11.0% after implementation (P < .001). A higher proportion of CDI patients were readmitted within 30 days of discharge (54.2% vs 33.0%; P = 0.001) during the post-implementation period.
There was a significant reduction in inappropriate CDI testing following the implementation of the order set. There was an observed increase in the proportion of patients who underwent recent gastrointestinal surgery which may have contributed to the increase in 30-day readmission rates during the post-implementation period.
•Stewardship for CDI using an electronic smart orders reduced inappropriate testing in a retrospective pre and post-implementation study.•Rate of inappropriate testing decreased in post-implementation time period.•Increase in 30-day readmissions in the post-implementation period may be explained by patient outcomes like recent GI surgery.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Clostridioides difficile - isolation & purification</subject><subject>Clostridium Infections - diagnosis</subject><subject>Community Health Services</subject><subject>Diagnostic Tests, Routine</subject><subject>Electronic health record</subject><subject>Female</subject><subject>Florida</subject><subject>Humans</subject><subject>Infection prevention and control</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Smart orders</subject><issn>0196-6553</issn><issn>1527-3296</issn><issn>1527-3296</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc2O0zAURi0EYsrAC7BAXg6LFP8mtsQGFWaoNBILYG05zjV1lcTFdkB9Gl4VRx1mycry9fmO5Psh9JqSLSW0fXfc2mNwW0aY2BKxpYo-QRsqWddwptunaEOobptWSn6FXuR8JIRo3srn6IorzSVhZIP-7KeTdQVHj-2MYQRXUpyDw3myqY7TAKnJULCPCQ_B_phjLutzgd82DfkQTmt2N9ZxCkOIA-TKeR9cGAGH2VdjiDO-2X3cv613bLGL07TMoZzxAexYDs4mwPlcldMKfI1LOeDbMVaffYmeeTtmePVwXqPvt5--7T4391_u9rsP941jvCtN2_fAJLeddi31WknuO6W8Ykpq4Z0VYmiZ0hpoz62QXPVEKS474bXr28Hya3Rz8Z5S_LlALmYK2cE42hnikg0nHVNUCikqyi6oSzHnBN6cUqjbOhtKzFqMOZq1GLMWY4gwtZgaevPgX_oJhsfIvyYq8P4CQP3lrwDJZBdgdjCEVFdohhj-5_8LLL-hPA</recordid><startdate>202408</startdate><enddate>202408</enddate><creator>Eckardt, Paula</creator><creator>Guran, Rachel</creator><creator>Jalal, Ayesha T.</creator><creator>Krishnaswamy, Shiv</creator><creator>Samuels, Shenae</creator><creator>Canavan, Kelsi</creator><creator>Martinez, Elsa A.</creator><creator>Desai, Ajay</creator><creator>Miller, Nancimae</creator><creator>Cano Cevallos, Edison J.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0392-5861</orcidid><orcidid>https://orcid.org/0000-0002-6798-6922</orcidid><orcidid>https://orcid.org/0000-0002-8357-0628</orcidid><orcidid>https://orcid.org/0000-0002-7281-6231</orcidid></search><sort><creationdate>202408</creationdate><title>Impact of an electronic smart order-set for diagnostic stewardship of Clostridiodes difficile infection (CDI) in a community healthcare system in South Florida</title><author>Eckardt, Paula ; Guran, Rachel ; Jalal, Ayesha T. ; Krishnaswamy, Shiv ; Samuels, Shenae ; Canavan, Kelsi ; Martinez, Elsa A. ; Desai, Ajay ; Miller, Nancimae ; Cano Cevallos, Edison J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c237t-6bbe253a79c61f9853f788f828594fca44d62899e1b3a4538b0883574f9cb6da3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Clostridioides difficile - isolation & purification</topic><topic>Clostridium Infections - diagnosis</topic><topic>Community Health Services</topic><topic>Diagnostic Tests, Routine</topic><topic>Electronic health record</topic><topic>Female</topic><topic>Florida</topic><topic>Humans</topic><topic>Infection prevention and control</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Smart orders</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Eckardt, Paula</creatorcontrib><creatorcontrib>Guran, Rachel</creatorcontrib><creatorcontrib>Jalal, Ayesha T.</creatorcontrib><creatorcontrib>Krishnaswamy, Shiv</creatorcontrib><creatorcontrib>Samuels, Shenae</creatorcontrib><creatorcontrib>Canavan, Kelsi</creatorcontrib><creatorcontrib>Martinez, Elsa A.</creatorcontrib><creatorcontrib>Desai, Ajay</creatorcontrib><creatorcontrib>Miller, Nancimae</creatorcontrib><creatorcontrib>Cano Cevallos, Edison J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of infection control</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Eckardt, Paula</au><au>Guran, Rachel</au><au>Jalal, Ayesha T.</au><au>Krishnaswamy, Shiv</au><au>Samuels, Shenae</au><au>Canavan, Kelsi</au><au>Martinez, Elsa A.</au><au>Desai, Ajay</au><au>Miller, Nancimae</au><au>Cano Cevallos, Edison J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of an electronic smart order-set for diagnostic stewardship of Clostridiodes difficile infection (CDI) in a community healthcare system in South Florida</atitle><jtitle>American journal of infection control</jtitle><addtitle>Am J Infect Control</addtitle><date>2024-08</date><risdate>2024</risdate><volume>52</volume><issue>8</issue><spage>893</spage><epage>899</epage><pages>893-899</pages><issn>0196-6553</issn><issn>1527-3296</issn><eissn>1527-3296</eissn><abstract>Inappropriate testing for Clostridiodes difficile infection (CDI) increases health care onset cases and contributes to overdiagnosis and overtreatment of patients in a community health care system.
An electronic smart order set for the testing of CDI was created and implemented to improve the appropriateness of testing. A retrospective review of patients who were tested for CDI, pre and post, was conducted to determine if inappropriate stool testing for CDI decreased post-implementation of the order set.
224 patients were tested for CDI during the study period with the post-implementation period having a higher proportion of patients who met appropriate testing criteria defined by presence of diarrhea (80.5% vs 61.3%; P = .002). The rate of inappropriate CDI stool testing decreased from 31.1% to 11.0% after implementation (P < .001). A higher proportion of CDI patients were readmitted within 30 days of discharge (54.2% vs 33.0%; P = 0.001) during the post-implementation period.
There was a significant reduction in inappropriate CDI testing following the implementation of the order set. There was an observed increase in the proportion of patients who underwent recent gastrointestinal surgery which may have contributed to the increase in 30-day readmission rates during the post-implementation period.
•Stewardship for CDI using an electronic smart orders reduced inappropriate testing in a retrospective pre and post-implementation study.•Rate of inappropriate testing decreased in post-implementation time period.•Increase in 30-day readmissions in the post-implementation period may be explained by patient outcomes like recent GI surgery.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>38935020</pmid><doi>10.1016/j.ajic.2024.04.181</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-0392-5861</orcidid><orcidid>https://orcid.org/0000-0002-6798-6922</orcidid><orcidid>https://orcid.org/0000-0002-8357-0628</orcidid><orcidid>https://orcid.org/0000-0002-7281-6231</orcidid></addata></record> |
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| ispartof | American journal of infection control, 2024-08, Vol.52 (8), p.893-899 |
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| subjects | Adult Aged Aged, 80 and over Clostridioides difficile - isolation & purification Clostridium Infections - diagnosis Community Health Services Diagnostic Tests, Routine Electronic health record Female Florida Humans Infection prevention and control Male Middle Aged Retrospective Studies Smart orders |
| title | Impact of an electronic smart order-set for diagnostic stewardship of Clostridiodes difficile infection (CDI) in a community healthcare system in South Florida |
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