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Development of a Larval Zebrafish Infection Model for Clostridioides difficile
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Prescriber Behavior in Clostridioides difficile Testing: A 3-Hospital Diagnostic Stewardship Intervention.

Masako Mizusawa1, Bryce A Small2, Yea-Jen Hsu3

  • 1Section of Infectious Diseases, Department of Internal Medicine, University of Missouri Kansas City, Missouri.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|May 25, 2019
PubMed
Summary

Computerized clinical decision support (CCDS) reduced Clostridioides difficile testing across three hospitals without adverse events. Senior providers more frequently adhered to CCDS recommendations compared to junior medical staff.

Keywords:
C. difficilecomputerized clinical decision supportdiagnostic stewardship interventionprovider behavior

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Area of Science:

  • Healthcare Informatics
  • Infectious Disease Management
  • Clinical Decision Support Systems

Background:

  • Clostridioides difficile infections (CDI) pose a significant healthcare challenge.
  • Inappropriate diagnostic testing contributes to healthcare costs and antimicrobial resistance.
  • Clinical decision support systems offer potential solutions for optimizing testing protocols.

Purpose of the Study:

  • To evaluate the impact of computerized clinical decision support (CCDS) on Clostridioides difficile testing rates.
  • To assess the safety and provider adherence associated with CCDS implementation.

Main Methods:

  • Implementation of a CCDS tool in three hospital settings.
  • Monitoring average weekly Clostridioides difficile test rates per 1000 inpatient days before and after CCDS implementation.
  • Tracking adverse events and analyzing provider adherence based on seniority.

Main Results:

  • Significant reductions in Clostridioides difficile testing were observed across all three hospitals.
  • Average weekly test rates decreased from 12.6 to 9.5, 10.1 to 6.4, and 14.0 to 9.6 per 1000 inpatient days.
  • No adverse events were associated with the CCDS implementation, and senior providers showed higher adherence rates.

Conclusions:

  • CCDS is an effective tool for reducing unnecessary Clostridioides difficile testing.
  • The implementation of CCDS is safe and can be successfully integrated into clinical workflows.
  • Provider seniority influences the adoption of CCDS recommendations, highlighting a potential area for targeted education.