Patient Outcomes With Prevented vs Negative Clostridioides difficile Tests Using a Computerized Clinical Decision...

Area of Science:

• Infectious Diseases
• Clinical Informatics
• Healthcare Quality Improvement

Background:

• Overtesting and overdiagnosis of Clostridioides difficile infection are prevalent concerns.
• Diagnostic stewardship interventions aim to improve C. difficile test utilization.
• The safety of these interventions, particularly regarding delayed diagnoses, requires thorough investigation.

Purpose of the Study:

• To evaluate the safety and effectiveness of a computerized clinical decision support tool for reducing inappropriate C. difficile testing.
• To compare patient outcomes between prevented C. difficile tests and negative test results.

Main Methods:

• Retrospective case-control study at a university medical center.
• Comparison of outcomes for patients with prevented C. difficile nucleic acid amplification tests versus negative results.
• Chart reviews for patients with subsequent positive tests or C. difficile-active antibiotics post-intervention.

Main Results:

• Prevented C. difficile tests were not significantly associated with adverse outcomes (mortality or ICU transfer).
• 37% of prevented tests were followed by a completed test within 7 days, with 11 positive results.
• Case reviews indicated delays were clinically warranted or did not result in adverse events.

Conclusions:

• Computerized clinical decision support for C. difficile diagnostic stewardship appears safe and effective.
• This approach can successfully reduce inappropriate inpatient testing for C. difficile infection.