Clostridioides difficile dynamic electronic order panel, an effective automated intervention to reduce inappropriate...

Area of Science:

• Infectious Diseases
• Clinical Informatics
• Healthcare Quality Improvement

Background:

• Inappropriate ordering of Clostridioides difficile (C. diff) diagnostics leads to antibiotic misuse and misdiagnosis.
• Manual review of test orders can divert resources from infection control and stewardship efforts.

Purpose of the Study:

• To develop and implement an evidence-based clinical algorithm and electronic order-entry tool to improve the appropriateness of C. diff testing.
• To evaluate the impact of this intervention on C. diff test ordering and positive test rates.

Main Methods:

• Developed an evidence-based algorithm with criteria for C. diff testing appropriateness.
• Implemented an electronic medical record (EMR) order-entry tool displaying dynamic guidance based on patient data.
• Compared intervention rates to a historic baseline using a best-practice advisory at five hospitals.

Main Results:

• The intervention significantly reduced C. diff ordering (IRR, 0.74) and positive tests (IRR, 0.83).
• Sustained reductions in orders were observed in academic hospitals, with new reductions in community hospitals.
• The dynamic order panel proved more effective than a best-practice advisory.

Conclusions:

• An EMR-integrated, evidence-based dynamic order panel effectively reduced C. diff ordering and positive test rates.
• The intervention's impact varied between academic and community hospital settings.
• This tool supports appropriate diagnostic testing and antibiotic stewardship.