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Related Experiment Video

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Reducing Overutilization of Testing for Clostridium difficile Infection in a Pediatric Hospital System: A Quality

J Michael Klatte1, Rangaraj Selvarangan2, Mary Anne Jackson2

  • 1Department of Pediatrics, Baystate Medical Center and Tufts University School of Medicine, Springfield, Massachusetts; and james.klattemd@baystatehealth.org.

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Summary

Implementing automatic laboratory declination of inappropriate stool specimens significantly reduced Clostridium difficile testing, leading to substantial cost savings. Physician ordering practices, however, did not show sustained improvement.

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Area of Science:

  • Clinical diagnostics
  • Laboratory medicine
  • Infectious disease testing

Background:

  • Overuse of Clostridium difficile laboratory testing is a significant issue.
  • Nondiarrheal stool specimens and specimens from young children are frequently submitted inappropriately.

Purpose of the Study:

  • To reduce Clostridium difficile laboratory testing by decreasing submissions of nondiarrheal stool specimens and specimens from children ≤12 months.
  • To determine patient and laboratory cost savings associated with reduced testing.

Main Methods:

  • A multifaceted initiative including provider education, computerized order entry modifications, and automatic laboratory declination of inappropriate specimens.
  • Run charts and p-charts were used to analyze testing submission and testing rates.
  • Cost savings were assessed post-intervention.

Main Results:

  • Automatic laboratory declination led to a sustained decrease in tested specimens, from 100% to 53.8%.
  • Significant cost savings were achieved: nearly $3600 for the laboratory and ~$32,000 for patients.
  • Provider education and order entry modifications did not result in sustained changes in physician ordering practices.

Conclusions:

  • Automatic laboratory declination is effective in reducing inappropriate Clostridium difficile testing and generating cost savings.
  • While laboratory interventions show success, sustained changes in physician ordering behavior require further strategies.