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A diagnostic stewardship approach to prevent unnecessary testing of an enteric bacterial molecular panel
Victoria L Campodónico1, Ann Hanlon1, Michael W Mikula1
1Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine , Baltimore, Maryland, USA.
Importance:
Testing for enteric bacterial pathogens in patients hospitalized for more than 3 days is almost always inappropriate. Our study validates the utility of the 3-day rule and the use of clinical decision support tools to decrease unnecessary testing of enteropathogenic bacteria other than C. difficile. Overriding the restriction was very low yield. Our study highlights the importance of diagnostic stewardship and further refines the criteria for allowing providers to override the restriction while monitoring the impact of the interventions.
Insights
Testing hospitalized patients for enteric bacteria after 3 days is usually unnecessary. This study confirms the 3-day rule and decision support tools reduce inappropriate testing, with few exceptions.
Area of Science:
- Clinical microbiology
- Diagnostic stewardship
- Infectious disease
Background:
- Enteric bacterial pathogen testing is frequently overused in hospitalized patients.
- The 3-day rule aims to limit unnecessary diagnostic workups for these infections.
- Clinical decision support (CDS) tools can aid in implementing such guidelines.
Purpose of the Study:
- To validate the effectiveness of the 3-day rule for enteric bacterial pathogen testing.
- To assess the impact of CDS tools on reducing inappropriate testing.
- To refine criteria for overriding the 3-day restriction and monitor outcomes.
Main Methods:
- Retrospective analysis of laboratory testing data.
- Implementation of a 3-day rule with CDS alerts.
- Auditing of overridden restrictions and subsequent test yields.
Main Results:
- The 3-day rule and CDS significantly decreased unnecessary enteric bacterial testing.
- Overriding the restriction was associated with a very low yield of positive results.
- Diagnostic stewardship interventions proved effective in optimizing testing practices.
Conclusions:
- The 3-day rule is a valuable tool for diagnostic stewardship in enteric bacterial testing.
- CDS tools enhance the implementation and adherence to testing guidelines.
- Refined criteria for overriding restrictions can further improve appropriate test utilization.
