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The impact of an electronic medical record nudge on reducing testing for hospital-onset Clostridioides difficile infection
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February 10 2020
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Source: Infect Control Hosp Epidemiol. 41(4):411-417
Details:
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Alternative Title:Infect Control Hosp Epidemiol
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Personal Author:
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Description:Objective:
To determine the effect of an electronic medical record (EMR) nudge at reducing total and inappropriate orders testing for hospital-onset Clostridioides difficile infection (HO-CDI).
Design:
An interrupted time series analysis of HO-CDI orders two years before and two years after the implementation of an EMR intervention designed to reduce inappropriate HO-CDI testing. Orders for C. difficile testing were considered inappropriate if the patient received a laxative or stool softener in the previous 24 hours.
Setting:
Four hospitals in an academic healthcare network.
Patients:
All patients with a C. difficile order after hospital day three.
Intervention:
C. difficile orders in patients administered a laxative or stool softener in <24 hours triggered an EMR alert defaulting to order cancellation (“nudge”).
Results:
Of the 17,694 HO-CDI orders, 7% were inappropriate (8% pre- vs. 6% post-intervention, p < 0.001). Monthly HO-CDI orders decreased by 21% post-intervention (level change rate ratio [RR]: 0.79; 95% confidence interval [CI] 0.73–0.86) and the rate continued to decrease (post-intervention trend change RR: 0.99; 95% CI 0.98–1.00). The intervention was not associated with a level change in inappropriate HO-CDI orders (RR: 0.80; 95% CI 0.61–1.05), but the post-intervention inappropriate order rate decreased over time (RR: 0.95; 95% CI 0.93–0.97).
Conclusion:
An EMR nudge targeted to minimize inappropriate ordering for C. difficile was effective at reducing HO-CDI orders, and likely contributed to decreasing the post-intervention inappropriate HO-CDI order rate.
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Source:
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Pubmed ID:32036798
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Pubmed Central ID:PMC7909614
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