The impact of an electronic medical record nudge on reducing testing for hospital-onset Clostridioides difficile infection

Details

• Alternative Title:
  Infect Control Hosp Epidemiol
• Personal Author:
  Howard-Anderson, Jessica ; Sexton, Mary Elizabeth ; Robichaux, Chad ; Wiley, Zanthia ; Varkey, Jay B. ; Suchindran, Sujit ; Albrecht, Benjamin ; Jones, K. Ashley ; Fridkin, Scott K. ; Jacob, Jesse T.
• 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.
  
  
• Subjects:
  Article
• Source:
  Infect Control Hosp Epidemiol. 41(4):411-417
• Pubmed ID:
  32036798
• Pubmed Central ID:
  PMC7909614
• Document Type:
  Journal Article
• Funding:
  TL1 TR002382/TR/NCATS NIH HHS/United States ; U54 CK000164/CK/NCEZID CDC HHS/United States ; UL1 TR002378/TR/NCATS NIH HHS/United States
• Volume:
  41
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:c4af2f0a116a422d92bf0e7d6810423f07af2596b2c751d6e5402c3dd48ecd3f
• Download URL:
  https://stacks.cdc.gov/view/cdc/103637/cdc_103637_DS1.pdf
• File Type:
  [PDF - 1.11 MB ]