Hostname: page-component-cb9f654ff-65tv2 Total loading time: 0 Render date: 2025-08-28T01:28:13.380Z Has data issue: false hasContentIssue false
  • English
  • Français

Utilizing a real-time discussion approach to improve the appropriateness of Clostridioides difficile testing and the potential unintended consequences of this strategy

Published online by Cambridge University Press:  29 June 2020

Lana Dbeibo Open the ORCID record for Lana Dbeibo [Opens in a new window] ,
Allison Brinkman ,
Cole Beeler ,
William Fadel ,
William Snyderman ,
Nicole Hatfield ,
Joshua Sadowski ,
Yun Wang ,
Kristen Kelley  and
Douglas Webb
...Show all authors
Lana Dbeibo*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana Department of Infection Prevention, Indiana University Health, Indianapolis, Indiana Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
Allison Brinkman
Affiliation:
Department of Infection Prevention, Indiana University Health, Indianapolis, Indiana
Cole Beeler
Affiliation:
Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana Department of Infection Prevention, Indiana University Health, Indianapolis, Indiana Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
William Fadel
Affiliation:
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
William Snyderman
Affiliation:
Department of Infection Prevention, Indiana University Health, Indianapolis, Indiana
Nicole Hatfield
Affiliation:
Department of Infection Prevention, Indiana University Health, Indianapolis, Indiana
Joshua Sadowski
Affiliation:
Department of Infection Prevention, Indiana University Health, Indianapolis, Indiana
Yun Wang
Affiliation:
Department of Infection Prevention, Indiana University Health, Indianapolis, Indiana
Kristen Kelley
Affiliation:
Department of Infection Prevention, Indiana University Health, Indianapolis, Indiana
Douglas Webb
Affiliation:
Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana Department of Infection Prevention, Indiana University Health, Indianapolis, Indiana
Jose Azar
Affiliation:
Department of Quality and Safety, Indiana University Health, Indianapolis, Indiana Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
Areeba Kara
Affiliation:
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
*
Author for correspondence: Lana Dbeibo, E-mail: ldbeibo@iu.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

We report electronic medical record interventions to reduce Clostridioides difficile testing risk ‘alert fatigue.’ We used a behavioral approach to diagnostic stewardship and observed a decrease in the number of tests ordered of ~4.5 per month (P < .0001). Although the number of inappropriate tests decreased during the study period, delayed testing increased.

Information

Type
Concise Communication
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 10 , October 2020 , pp. 1215 - 1218
Check for updates
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

PREVIOUS PRESENTATION: An abstract related to this manuscript has been accepted for the 2020 SHEA conference.

References

Fabre, V, Markou, T, Sick-Samuels, A, et al.Impact of case-specific education and face-to-face feedback to prescribers and nurses in the management of hospitalized patients with a positive Clostridium difficile test. Open Forum Infect Dis 2018;5:ofy226.10.1093/ofid/ofy226CrossRefGoogle ScholarPubMed
Madden, GR, German Mesner, I, Cox, HL, et al.Reduced Clostridium difficile tests and laboratory-identified events with a computerized clinical decision support tool and financial incentive. Infect Control Hosp Epidemiol 2018;39:737–740.10.1017/ice.2018.53CrossRefGoogle ScholarPubMed
Madden, GR, Weinstein, RA, Sifri, CD. Diagnostic stewardship for healthcare-associated infections: opportunities and challenges to safely reduce test use. Infect Control Hosp Epidemiol 2018;39:214–218.10.1017/ice.2017.278CrossRefGoogle ScholarPubMed
McDonald, LC, Gerding, DN, Johnson, S, et al.Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2018;66:e1–e48.10.1093/cid/cix1085CrossRefGoogle Scholar
Rock, C, Maragakis, LL. Diagnostic stewardship for Clostridiodes difficile testing: from laxatives to diarrhea and beyond. Clin Infect Dis 2019; pii: ciz982. doi: 10.1093/cid/ciz982.Google Scholar
White, NC, Mendo-Lopez, R, Papamichael, K, et al.Laxative use does not preclude diagnosis or reduce disease severity in Clostridiodes difficile infection. Clin Infect Dis 2019; pii: ciz978. doi: 10.1093/cid/ciz978.Google Scholar
Kara, A, Tahir, M, Snyderman, W, Brinkman, A, Fadel, W, Dbeibo, L. Why do clinicians order inappropriate Clostridium difficile testing? An exploratory study. Am J Infect Control 2019;47:285–289.10.1016/j.ajic.2018.08.019CrossRefGoogle ScholarPubMed
Lewis, SJ, Heaton, KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol 1997;32:920–924.10.3109/00365529709011203CrossRefGoogle ScholarPubMed
Reed, JE, Card, AJ. The problem with plan-do-study-act cycles. BMJ Qual Safety 2016;25:147–152.10.1136/bmjqs-2015-005076CrossRefGoogle ScholarPubMed
Dbeibo, L, Kelley, K, Beeler, C, et al.Achieving Clostridioides difficile infection Health and Human Services 2020 goals: using agile implementation to bring evidence to the bedside. Infect Control Hosp Epidemiol 2020;41:237–239.Google Scholar
Azar, J, Kelley, K, Dunscomb, J, et al.Using the agile implementation model to reduce central line-associated bloodstream infections. Am J Infect Control 2019;47:33–37.10.1016/j.ajic.2018.07.008CrossRefGoogle ScholarPubMed
Pronovost, PJ. 2011. Navigating adaptive challenges in quality improvement. BMJ Qual Safety 20:560–563.10.1136/bmjqs-2011-000026CrossRefGoogle ScholarPubMed
Sayedy, L, Kothari, D, Richards, RJ. Toxic megacolon associated Clostridium difficile colitis. World J Gastrointest Endosc 2010;2:293–297.10.4253/wjge.v2.i8.293CrossRefGoogle ScholarPubMed
Donskey, CJ. Preventing transmission of Clostridium difficile: is the answer blowing in the wind? Clin Infect Dis 2010;50:1458–1461.10.1086/652649CrossRefGoogle ScholarPubMed
Supplementary material: Image

Dbeibo et al. supplementary material

Dbeibo et al. supplementary material 1

Download Dbeibo et al. supplementary material(Image)
Image 2.4 MB
Supplementary material: Image

Dbeibo et al. supplementary material

Dbeibo et al. supplementary material 2

Download Dbeibo et al. supplementary material(Image)
Image 819.9 KB