Diagnostic stewardship to improve patient outcomes and healthcare-associated infection (HAI) metrics

Singh, Harjot K.; Claeys, Kimberly C.; Advani, Sonali D.; Ballam, Yolanda J.; Penney, Jessica; Schutte, Kirsten M.; Baliga, Christopher; Milstone, Aaron M.; Hayden, Mary K.; Morgan, Daniel J.; Diekema, Daniel J.

doi:10.1017/ice.2023.284

Cited by 8 publications

(4 citation statements)

References 52 publications

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“…However, this population has much to gain from diagnostic stewardship: reduced phlebotomy in patients who need frequent transfusions, less frequent detection of blood culture contaminants, improved antimicrobial use, and more accurate diagnosis of hospital-associated infections. [1][2][3][4][5] Ultimately, the balance between early detection of an infectious pathogen and avoidance of over-testing remains elusive in febrile neutropenia diagnostic investigations.…”

Section: Changing the Culture Of Blood Cultures: Opportunities For Di...mentioning

confidence: 99%

“…2 Therefore, consequences of unnecessary or inappropriately collected blood cultures can include increased antibiotic exposure, misclassification of central line-associated bloodstream infection (CLABSI), iatrogenic anemia, increased length of hospitalization, and increased healthcare costs. 2,3,5 These paired with a nationwide shortage of blood culture media bottles 11 underscore the importance of encouraging appropriate blood culture ordering by front-line clinicians.…”

Section: Changing the Culture Of Blood Cultures: Opportunities For Di...mentioning

confidence: 99%

“…Decreasing CLABSI rates is an important target for hospitals, which has led some centers to develop policies discouraging the collection of blood cultures directly from central lines given the challenges of distinguishing contamination from true bloodstream infection. 3 However, are patients with hematologic malignancies and indwelling…”

Section: Changing the Culture Of Blood Cultures: Opportunities For Di...mentioning

confidence: 99%

“…Emily A. Rosen 1,2 Erica J. Stohs 3 1 Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center,…”

Section: Data Availability Statementmentioning

confidence: 99%

See 3 more Smart Citations

Changing the culture of blood cultures: Opportunities for diagnostic stewardship in febrile neutropenia

Rosen,

Stohs

2024

Transplant Infectious Dis

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Section: Changing the Culture Of Blood Cultures: Opportunities For Di...mentioning

confidence: 99%

Section: Changing the Culture Of Blood Cultures: Opportunities For Di...mentioning

confidence: 99%

Section: Changing the Culture Of Blood Cultures: Opportunities For Di...mentioning

confidence: 99%

“…Emily A. Rosen 1,2 Erica J. Stohs 3 1 Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center,…”

Section: Data Availability Statementmentioning

confidence: 99%

See 2 more Smart Citations

Changing the culture of blood cultures: Opportunities for diagnostic stewardship in febrile neutropenia

Rosen,

Stohs

2024

Transplant Infectious Dis

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Clinical decision support in the electronic health record: a primer for antimicrobial stewards and infection preventionists: work smarter so end users don’t work harder

Smith,

Lee,

Holubar

et al. 2024

ASHE

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Objective: Computerized clinical decision support (CDS) assists healthcare professionals in making decisions to improve patient care. In the realms of antimicrobial stewardship (ASP) and infection prevention (IP) programs, CDS interventions can play a crucial role in optimizing antibiotic prescribing practices, reducing healthcare-associated infections, and promoting diagnostic stewardship when optimally designed. This primer article aims to provide ASP and IP professionals with a practical framework for the development, design, and evaluation of CDS interventions. Setting: Large academic medical center design: Established frameworks of CDS evaluation, “Five Rights” of CDS and the “Ten Commandments of Effective Clinical Decision Support”, were applied to two real-world examples of CDS tools, a Vancomycin Best Practice Advisory and a Clostridioides Difficile order panel, to demonstrate a structured approach to developing and enhancing the functionality of ASP/IP CDS interventions to promote efficacy and reduce unintended consequences of CDS. Conclusions: By outlining a structured approach for the development and evaluation of CDS interventions, with focus on end user engagement, efficiency and feasibility, ASP and IP professionals can leverage CDS to enhance IP/ASP quality improvement initiatives aimed to improve antibiotic utilization, diagnostic stewardship, and adherence to IP protocols.

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Provider & nursing perspectives on the “panculture”: opportunities for innovative diagnostic stewardship interventions

Gibas,

Mermel

2024

ASHE

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Objective: To examine practices of providers and nursing staff in evaluating febrile patients and identify drivers of excessive diagnostic testing. Design: Prospective multiple-choice surveys. Setting: Inpatient areas and the Emergency Department at Rhode Island Hospital (RIH) in Providence, RI. Participants & Methods: We conducted two surveys focused on the evaluation of febrile inpatients at RIH. One survey was of providers trained in internal medicine, surgery, pediatrics, emergency medicine, and neurology; the other survey was of nursing staff (registered nurses and certified nursing assistants), in inpatient areas and the emergency department. Results: 70 providers (9%) and 178 nursing staff (12%) completed the surveys. 64% of providers (n = 43) reported “always” or “often” ordering full fever workups and 67% of providers (n = 47) reported “always” or “often” physically evaluating febrile patients. Nurses were less likely than providers to report that providers “always” or “often” physically evaluate febrile patients (n = 80, 45%; P < 0.01) and more likely to report providers “always” or “often” order full fever workups (n = 135, 76%; P = 0.04). 71% of providers (n = 50) reported “always” or “often” receiving written handoffs. 86% of providers (n = 60) reported handoffs are “always” or “often” accurate; however, only 17% of providers responded these were “always” accurate. 77% of providers (n = 54) reported “always” or “often” following handoff instructions to obtain a full fever workup for febrile patients, regardless of clinical status. Responses differed significantly by unit type and provider specialty and position. Conclusions: This study elucidates drivers of inefficient and excessive utilization of diagnostic studies and identifies targets for diagnostic stewardship interventions.

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Diagnostic stewardship to improve patient outcomes and healthcare-associated infection (HAI) metrics

Cited by 8 publications

References 52 publications

Changing the culture of blood cultures: Opportunities for diagnostic stewardship in febrile neutropenia

Changing the culture of blood cultures: Opportunities for diagnostic stewardship in febrile neutropenia

Clinical decision support in the electronic health record: a primer for antimicrobial stewards and infection preventionists: work smarter so end users don’t work harder

Provider & nursing perspectives on the “panculture”: opportunities for innovative diagnostic stewardship interventions

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