88. Impact of a Computerized Clinical Decision Support Tool on clostridioides Difficile Testing and Oral Vancomycin Utilization as a Balancing Metric
Year: 2020
Type: conference-abstract
Abstract: Background Over diagnosis of hospital-onset Clostridioides difficile infection (HO-CDI) is directly tied to inappropriate C. difficile testing which does not distinguish between infected or colonized individuals. This can lead to inappropriate therapy. Multiple studies have utilized Computerized Clinical Decision Support (CCDS) tools to reduce inappropriate C. difficile testing. Our study looks at the impact of a Self-Assessment CCDS tools on C. difficile testing for HO-CDI and oral vancomycin utilization as a balancing metric. Methods Our institution utilizes a two-step test to diagnose HO-CDI that consists of toxin A/B enzyme immunoassay followed by a confirmatory PCR. We applied a self-assessment driven CCDS approach to reduce testing for HO-CDI. Our intervention was deployed in the 3rd quarter of 2018. It asked 3 questions about stool frequency, laxative use and previous C. difficile testing in the order itself. Inappropriate indications for testing included any of the following: < 3 bowel movements within 24 hours, receipt of a laxative within the past 48 hours, or a previous C. difficile test within the previous 7 days. Ordering providers would self-answer these questions. A ‘yes’ response to any of the three questions prevented further test ordering; though respondents had the freedom to change the answer and still proceed with the test order. We evaluated 3 metrics that were all calculated per 1000 inpatient census days: oral vancomycin usage, HO-CDI rates and C. difficile testing rates. Results Compared to baseline, our intervention resulted in a significant reduction of C. difficile testing and HO-CDI rates (Figure 1, Table 1). Oral vancomycin usage also decreased significantly (Figure 2, Table 1). Figure 1. C. difficile testing and Hospital Onset C. difficile Infection Rates by Month, Before and After Intervention Figure 2. Oral Vancomycin Utilization by Month, Before and After Intervention Table 1. Changes in Median Rates of C. difficile testing, Hospital Onset C. difficile Infections and Vancomycin Utilization, Before and After Intervention. Conclusion Our self-assessment driven CCDS-based diagnostic stewardship resulted in a significant reduction in inappropriate C. difficile testing for HO-CDI and HO-CDI rates. Oral vancomycin utilization as a balancing metric also decreased significantly. This was despite the use of a self-assessment driven approach with the freedom to change the answers in order to proceed with the test order. Disclosures All Authors: No reported disclosures
Source: Open Forum Infectious Diseases
Institutions: Denver Health Medical Center, University of Colorado Anschutz
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W3119485889