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Clinical decision support for gastrointestinal panel testing.

Nadia T Saif1, Cara Dooley1, Jonathan D Baghdadi1

  • 1Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.

Antimicrobial Stewardship & Healthcare Epidemiology : ASHE
|February 28, 2024
PubMed
Summary
This summary is machine-generated.

Clinical decision support (CDS) reduced gastrointestinal (GI) panel testing and inappropriate orders related to laxatives or diarrhea. However, overall inappropriate ordering of GI panels remained high, indicating a need for ongoing diagnostic stewardship.

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Area of Science:

  • Medical Informatics
  • Clinical Diagnostics
  • Health Services Research

Background:

  • Multiplex gastrointestinal polymerase chain reaction (PCR) testing panels (GI panels) are valuable diagnostic tools.
  • Appropriate ordering of GI panels is crucial for effective patient care and resource management.
  • Clinical decision support (CDS) systems integrated into electronic medical records (EMRs) can guide diagnostic test ordering.

Purpose of the Study:

  • To evaluate the effectiveness of a CDS intervention in improving the appropriate ordering of GI panels.
  • To assess the impact of CDS on the utilization and appropriateness of GI panel testing.

Main Methods:

  • A single-center, retrospective, before-after study was conducted at a tertiary care Veteran's Affairs Medical Center.
  • A CDS tool with a "soft stop" reminder was implemented in the EMR to prompt providers on five appropriateness criteria for GI panel orders.
  • Data from patients tested with a GI panel before (June 2022-November 2022) and after (November 2022-April 2023) CDS implementation were analyzed.

Main Results:

  • A significant decrease in the overall number of GI panel tests was observed post-implementation (IRR 0.61, p=0.003).
  • Inappropriate ordering due to laxative use or undocumented diarrhea significantly decreased post-intervention (IRR 0.37, p=0.012 and IRR 0.25, p=0.08, respectively).
  • Overall inappropriate ordering rates and outcome measures did not significantly differ between the pre- and post-implementation periods.

Conclusions:

  • CDS implementation effectively reduced GI panel testing and specific types of inappropriate ordering.
  • Despite reductions in certain inappropriate orders, overall inappropriate GI panel ordering remained high.
  • Continued diagnostic stewardship efforts are necessary to optimize the use of GI panel testing.