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Hardwiring diagnostic stewardship using electronic ordering restrictions for gastrointestinal pathogen testing
Jasmine R Marcelin1, Charlotte Brewer2, Micah Beachy3
1Division of Infectious Diseases,University of Nebraska Medical Center,Omaha,Nebraska.
Infection Control and Hospital Epidemiology
|April 24, 2019
Summary
Implementing an electronic health record (EHR) hard stop significantly reduced inappropriate gastrointestinal pathogen panel (GIPP) testing. This intervention decreased GIPP orders by 30%, improving appropriate test utilization in hospitalized patients.
Area of Science:
- Clinical Informatics
- Health Services Research
- Medical Diagnostics
Background:
- Gastrointestinal pathogen panel (GIPP) testing is often overutilized in hospitalized patients.
- Inappropriate testing can lead to increased healthcare costs and potential patient harm.
- Electronic health record (EHR) systems offer opportunities to optimize diagnostic test ordering.
Purpose of the Study:
- To assess the effectiveness of an EHR-based hard stop intervention in reducing inappropriate gastrointestinal pathogen panel (GIPP) testing.
- To evaluate the impact of the intervention on GIPP ordering rates among hospitalized patients with diarrhea.
Main Methods:
- A quasi-experimental study design was employed, comparing GIPP ordering before and after intervention.
- An EHR hard stop was implemented, limiting GIPP orders to once per admission or for patients hospitalized over 72 hours.
- Data from hospitalized patients with diarrhea were analyzed from two distinct periods.
Main Results:
- GIPP ordering rates decreased from 7.48 to 5.24 per 1,000 patient days post-intervention.
- A statistically significant 30% reduction in total GIPP ordering rates was observed (RR, 0.70; 95% CI, 0.63-0.78).
- The intervention effectively reduced GIPP testing in patients hospitalized for over 72 hours.
Conclusions:
- EHR hard stops are an effective strategy for curbing inappropriate gastrointestinal pathogen panel (GIPP) testing.
- Implementing such alerts can lead to significant reductions in diagnostic test utilization.
- This approach supports more judicious use of laboratory resources and potentially improves patient care pathways.
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