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Hardwiring diagnostic stewardship using electronic ordering restrictions for gastrointestinal pathogen testing

Published online by Cambridge University Press:  23 April 2019

Jasmine R. Marcelin Open the ORCID record for Jasmine R. Marcelin [Opens in a new window] ,
Charlotte Brewer ,
Micah Beachy ,
Elizabeth Lyden ,
Tammy Winterboer ,
Caitlin N. Murphy ,
Paul D. Fey ,
Lauren Hood  and
Trevor C. Van Schooneveld
Jasmine R. Marcelin*
Affiliation:
Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
Charlotte Brewer
Affiliation:
Nebraska Medicine, Omaha, Nebraska
Micah Beachy
Affiliation:
Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
Elizabeth Lyden
Affiliation:
College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
Tammy Winterboer
Affiliation:
Nebraska Medicine, Omaha, Nebraska
Caitlin N. Murphy
Affiliation:
Department of Pathology & Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
Paul D. Fey
Affiliation:
Department of Pathology & Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
Lauren Hood
Affiliation:
Nebraska Medicine, Omaha, Nebraska
Trevor C. Van Schooneveld
Affiliation:
Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
*
Author for correspondence: Jasmine R. Marcelin, Email: jasmine.marcelin@unmc.edu
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Abstract

Objective:

To evaluate the impact of a hard stop in the electronic health record (EHR) on inappropriate gastrointestinal pathogen panel testing (GIPP).

Design:

We used a quasi-experimental study to evaluate testing before and after the implementation of an EHR alert to stop inappropriate GIPP ordering.

Setting:

Midwest academic medical center.

Participants:

Hospitalized patients with diarrhea for which GIPP testing was ordered, between January 2016 through March 2017 (period 1) and April 2017 through June 2018 (period 2).

Intervention:

A hard stop in the EHR prevented clinicians from ordering a GIPP more than once per admission or in patients hospitalized for >72 hours.

Results:

During period 1, 1,587 GIPP tests were ordered over 212,212 patient days, at a rate of 7.48 per 1,000 patient days. In period 2, 1,165 GIPP tests were ordered over 222,343 patient days, at a rate of 5.24 per 1,000 patient days. The Poisson model estimated a 30% reduction in total GIPP ordering rates between the 2 periods (relative risk, 0.70; 95% confidence interval [CI], 0.63–0.78; P < .001). The rate of inappropriate tests ordered decreased from 21.5% to 4.9% between the 2 periods (P < .001). The total savings calculated factoring only GIPP orders that triggered the hard stop was ∼$67,000, with potential savings of $168,000 when factoring silent best-practice alert data.

Conclusions:

A simple hard stop alert in the EHR resulted in significant reduction of inappropriate GIPP testing, which was associated with significant cost savings. Clinicians can practice diagnostic stewardship by avoiding ordering this test more than once per admission or in patients hospitalized >72 hours.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 6 , June 2019 , pp. 668 - 673
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION: Portions of data from this manuscript were presented at IDWeek 2018 on October 5, 2018, in San Francisco, California.

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