The Use of a Computerized Provider Order Entry Alert to Decrease Rates of Clostridium difficile Testing in Young...

Area of Science:

• Infectious Disease Epidemiology
• Clinical Informatics
• Pediatric Healthcare

Background:

• Infants and young children are often colonized with Clostridioides difficile (C. difficile) but rarely develop symptomatic illness.
• Despite low disease prevalence, C. difficile testing is common in pediatric populations.
• Over-testing contributes to healthcare costs and potential for misdiagnosis.

Purpose of the Study:

• To implement and evaluate a computerized provider order entry (CPOE) alert to reduce C. difficile testing in infants and young children.
• To align C. difficile diagnostic practices with American Academy of Pediatrics recommendations.
• To assess the impact of the CPOE alert on testing rates and patient outcomes.

Main Methods:

• An interventional, age-targeted before-and-after trial was conducted.
• A CPOE alert was implemented, advising against C. difficile testing in children under 36 months, with an optional override.
• Educational seminars were provided to healthcare providers regarding appropriate C. difficile testing guidelines.

Main Results:

• The monthly C. difficile testing rate decreased significantly for children aged 0-11 months (11.5 to 0 per 10,000 patient-days) and 12-35 months (61.6 to 30.1 per 10,000 patient-days).
• No significant change in testing rates was observed for children aged 36 months and older, who were not targeted by the alert.
• No complications were reported in children who tested positive for C. difficile.

Conclusions:

• A CPOE alert effectively reduced C. difficile testing rates in children under 35 months old.
• The intervention demonstrated a significant decrease in unnecessary diagnostic procedures without adverse events.
• CPOE alerts are a valuable tool for optimizing C. difficile testing strategies in pediatric settings.