Improving Stewardship of Clostridioides difficile Testing with EMR and Provider Phone Calls

C. difficile Testing Stewardship

Authors

  • Joseph Joslin KU School of Medicine-Wichita
  • Elizabeth Ablah, Ph.D., MPH
  • Hayrettin Okut, Ph.D.
  • Lauren Bricker, Pharm.D.
  • Maha Assi, M.D., MPH

DOI:

https://doi.org/10.17161/kjm.vol15.15884

Keywords:

Clostridioides difficile, nosocomial infection, healthcare associated infection

Abstract

Introduction. Modern laboratory techniques cannot differentiate between Clostridium difficile (C. difficile) colonization and infection. Therefore, testing must be clinically indicated. To reduce hospital-onset of C. difficile infections (HO-CDI), Ascension Via Christi-Wichita (AVC-Wichita) intervened in three stages by introducing: 1) a C. difficile testing algorithm, 2) an electronic medical record (EMR)-based decision support system to enforce said algorithm, and 3) phone calls from the infection prevention department to providers to discontinue tests not collected within 24 hours of the order. The goal of this study was to determine if these interventions improved the HO-CDI rate.

Methods. At AVC-Wichita, the three study periods were compared: baseline with algorithm training only, the EMR intervention, and the EMR intervention with additional phone calls (EMR + phone calls). Data were abstracted from the hospital EMR.

Results. 311 charts were reviewed. Adherence to the algorithm increased from 34% at baseline to 52% after the EMR intervention (p=0.010). During the EMR + phone calls time-period, more tests were discontinued (87%, n=39) compared to baseline (54%, n=15) and EMR (54%, n=15, p=0.003). The HO-CDI rate ranged from 8.5 cases per 10,000 patient-days at baseline, to 7.9 during EMR, to 4.0 during EMR + Phone calls (p=0.007).

Conclusions. The EMR and EMR + phone call interventions were associated with a significant decrease in the HO-CDI rate and an increase in provider adherence to the algorithm.

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Published

2022-04-29

How to Cite

Joslin, J., Ablah, E., Okut, H., Bricker, L., & Assi, M. (2022). Improving Stewardship of Clostridioides difficile Testing with EMR and Provider Phone Calls : C. difficile Testing Stewardship . Kansas Journal of Medicine, 15(1), 135–138. https://doi.org/10.17161/kjm.vol15.15884

Issue

Section

Original Research