Journal article
Clinical Decision Support Systems to Reduce Unnecessary Clostridoides difficile Testing Across Multiple Hospitals
Clinical infectious diseases, Vol.75(7), pp.1187-1193
02/01/2022
DOI: 10.1093/cid/ciac074
PMID: 35100620
Abstract
Inappropriate C. difficile testing has adverse consequences for the patient, hospital, and public health. Computerized Clinical Decision Supports (CCDS) in the Electronic Health Record (EHR) may reduce C. difficile test ordering; however, effectiveness of different approaches, ease of use, and best fit into the healthcare providers' (HCP) workflow, are not well understood.
Nine academic and 6 community U.S. hospitals participated in this 2-year cohort study. CCDS (hard- or soft-stop) triggered when duplicate C. difficile test order attempted, or if laxatives were recently received. The primary outcome was the difference in testing rates pre- and post-CCDS interventions, using incident rate ratios (IRR) and mixed effect Poisson regression models. We performed qualitative evaluation (contextual inquiry, interviews, focus groups) based on a human factors model. We identified themes using a codebook with primary- and sub-nodes.
In 9 hospitals implementing hard-stop CCDS and 4 hospitals implementing soft-stop CCDS, C. difficile testing IRR reduction was 33% (95% CI, 30-36%), and 23% (95% CI 21-25%), respectively. Two hospitals implemented a non-EMR based human intervention with IRR reduction of 21% (95% CI 15-28%). HCPs reported generally favorable experiences, and highlighted time efficiencies such as inclusion of the patients most recent laxative administration on the CCDS. Organizational factors including hierarchical cultures, and communication between HCPs caring for the same patient, impact CCDS acceptance and integration.
CCDS reduced unnecessary C. difficile testing and were perceived positively by HCPs when integrated into their workflow, and when displayed relevant patient specific information needed for decision-making.
Details
- Title: Subtitle
- Clinical Decision Support Systems to Reduce Unnecessary Clostridoides difficile Testing Across Multiple Hospitals
- Creators
- Clare Rock - Johns Hopkins University School of Medicine, Baltimore, Maryland, United StatesOluchi Abosi - University of Iowa Hospitals & Clinics, Iowa City, Iowa, United StatesSusan Bleasdale - University of Illinois College of Medicine at Chicago, Chicago, United StatesErin Colligan - NORC at the University of Chicago, Chicago IL 60603, United StatesDaniel J Diekema - University of Iowa Carver College of Medicine, Iowa City, Iowa, United StatesPrashila Dullabh - NORC at the University of Chicago, Chicago IL 60603, United StatesAyse P Gurses - Johns Hopkins University School of Medicine, Baltimore, Maryland, United StatesKrysta Heaney-Huls - NORC at the University of Chicago, Chicago IL 60603, United StatesJesse T Jacob - Emory University School of Medicine, Atlanta, Georgia, United StatesSheetal Kandiah - Emory University School of Medicine, Atlanta, Georgia, United StatesSonam Lama - NORC at the University of Chicago, Chicago IL 60603, United StatesSurbhi Leekha - University of Maryland School of Medicine, Baltimore, Maryland, United StatesJeanmarie Mayer - University of Utah School of Medicine, Salt Lake City, Utah, United StatesAlfredo J Mena Lora - University of Illinois College of Medicine at Chicago, Chicago, United StatesDaniel J Morgan - University of Maryland School of Medicine, Baltimore, Maryland, United StatesPatience Osei - Johns Hopkins University School of Medicine, Baltimore, Maryland, United StatesSara Pau - Johns Hopkins University School of Medicine, Baltimore, Maryland, United StatesJorge L Salinas - University of Iowa Carver College of Medicine, Iowa City, Iowa, United StatesEmily Spivak - University of Utah School of Medicine, Salt Lake City, Utah, United StatesEric Wenzler - University of Illinois College of Pharmacy at Chicago, Chicago, United StatesSara E Cosgrove - Johns Hopkins University School of Medicine, Baltimore, Maryland, United StatesCDC Prevention Epicenter Program
- Resource Type
- Journal article
- Publication Details
- Clinical infectious diseases, Vol.75(7), pp.1187-1193
- DOI
- 10.1093/cid/ciac074
- PMID
- 35100620
- NLM abbreviation
- Clin Infect Dis
- eISSN
- 1537-6591
- Grant note
- DOI: 10.13039/100000030, name: Centers for Disease Control and Prevention, award: 6 U01CK000554-02-02
- Language
- English
- Electronic publication date
- 02/01/2022
- Academic Unit
- Infectious Diseases; Pathology; Internal Medicine
- Record Identifier
- 9984213450002771
Metrics
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