Prescriber Behavior in Clostridioides difficile Testing: A 3-Hospital Diagnostic Stewardship Intervention

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.