SEE the DIFFerence: Reducing unnecessary C. difficile orders through clinical decision support in a large, urban safety-net system

Krouss, Mona; Israilov, Sigal; Alaiev, Daniel; Talledo, Joseph; Chandra, Komal; Zaurova, Milana; Manchego, Peter Alacron; Cho, Hyung J.

doi:10.1016/j.ajic.2022.11.003

Cited by 10 publications

(5 citation statements)

References 20 publications

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“…The quality of stool specimens is important for testing. A previous study describing a DS for CDI based on a clinical decision support system aimed at reducing excessive testing 22 excluded solid stool specimens from the testing criteria. 23 On the other hand, on the assumption that the critical issue was unawareness of the importance of CDI diagnostic testing rather than the qualities of the stool specimen, the present study did not restrict testing.…”

Section: Discussionmentioning

confidence: 99%

Implementation of multifaceted diagnostic stewardship for Clostridioides difficile infection during the COVID-19 pandemic at a small Japanese hospital

Sasaki,

Yano,

Umehara

et al. 2024

ASHE

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Objective: Clostridioides difficile infection (CDI) is a common, healthcare-associated infection. However, in Japan, testing for CDI is infrequent, suggesting that its incidence may be underestimated. This study aimed to examine the implementation of a multifaceted, diagnostic stewardship (DS) for CDI in a small Japanese hospital during the coronavirus 2019 pandemic. Design: Before-after study. Setting: A small Japanese community hospital. Participants: Healthcare workers including physicians, nurses, and pharmacists. Interventions: A multifaceted intervention including (1) the addition of CD testing criteria to the hospital guidelines; (2) provision of a tutorial on CD testing to physicians, nurses, and pharmacists; (3) assessment by clinical pharmacists and nurses of the need for CD testing in patients with nosocomial diarrhea and issuance of recommendations for CD testing to physicians; (4) reporting of data on the CD testing rate and CDI incidence in the study center. Results: The CD testing rate increased before the pandemic (+0.16/10,000 patient-days (PD); P = .28), decreased significantly during the pandemic (−0.79/10,000 PD; P = .02), and then increased significantly immediately after the implementation of the intervention (+29.6/10,000 PD; P < .01). Similarly, the CDI incidence increased significantly before the pandemic (+0.26/10,000 PD; P = .02) and decreased significantly during the pandemic (−0.49/10,000 PD; P = .01). Implementation of the intervention resulted in an immediate and significant increase in the CDI incidence (+6.2/10,000 PD; P < .01). Conclusion: Multifaceted DS involving multidisciplinary specialists was effective in improving CD testing, suggesting that appropriate testing can contribute to diagnosing CDI accurately.

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Section: Discussionmentioning

confidence: 99%

Implementation of multifaceted diagnostic stewardship for Clostridioides difficile infection during the COVID-19 pandemic at a small Japanese hospital

Sasaki,

Yano,

Umehara

et al. 2024

ASHE

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“…Among clinician types, we note a lower tendency of compliance with the BPA among nurse practitioners compared to others. The literature on a clinician‐type variation on overuse remains mixed, and often advanced practitioners get categorized together between nurse practitioners and physician associates, but differences in training and culture may exist, including within nursing 26–28 . Future studies may be warranted in this area.…”

Section: Discussionmentioning

confidence: 99%

“…The literature on a clinician-type variation on overuse remains mixed, and often advanced practitioners get categorized together between nurse practitioners and physician associates, but differences in training and culture may exist, including within nursing. [26][27][28] Future studies may be warranted in this area. Among clinician specialties, behavioral health and rehab medicine may have lower rates of adhering to the nudge because they are less likely to initiate and stop telemetry compared to clinicians in medicine, critical care, and surgery.…”

Section: Discussionmentioning

confidence: 99%

Tell‐a provider about tele: Reducing overuse of telemetry across 10 hospitals in a safety net system

Krouss

Israilov

Alaiev

et al. 2022

Journal of Hospital Medicine

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Background: Telemetry is often a scarce resource at hospitals and is important for arrhythmia and myocardial ischemia detection. Overuse of telemetry monitoring leads to alarm fatigue resulting in failure to respond to arrhythmias, patient harm, and possible unnecessary testing.Methods: This quality improvement initiative was implemented across NYC Health and Hospitals, an 11-hospital urban safety net system. The electronic health record intervention involved the addition of a mandatory indication in the telemetry order and a best practice advisory (BPA) that would fire after the recommended time period for reassessment had passed. Results:The average telemetry hours per patient encounter went from 60.1 preintervention to 48.4 postintervention, a 19.5% reduction (p < .001). When stratified by the 11 hospitals, decreases ranged from 9% to 30%. The BPA had a 53% accept rate and fired 52,682 times, with 27,938 "discontinue telemetry" orders placed. The true accept rate was 50.4%, as there was a 2.6% 24-h reorder rate.There was variation based on clinician specialty and clinician type (attending, fellow, resident, physician associate, nurse practitioner). Conclusion:We successfully reduced telemetry monitoring across a multisite safety net system using solely an electronic health record (EHR) intervention. This expands on previous telemetry monitoring reduction initiatives using EHR interventions at single academic sites. Further study is needed to investigate variation across clinician type, specialty, and post-acute sites.

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“…Limitations of NAAT include a higher average cost than alternative testing for the detection of asymptomatic colonization [ 9 ]. Among healthy adults, C. difficile colonization without clinical signs of CDI ranges from 0% to 17.5%, while hospitalized adults show a higher prevalence, ranging from 0% to 51% [ 35 , 36 ]. Molecular testing does not detect active toxin production, thus leading to specificity issues in the diagnosis of CDI when used alone [ 9 ].…”

Section: Laboratory Tests To Diagnose CDImentioning

confidence: 99%

“…Molecular testing does not detect active toxin production, thus leading to specificity issues in the diagnosis of CDI when used alone [ 9 ]. Unnecessary treatment of asymptomatic colonized individuals can lead to adverse effects [ 35 ].…”

Section: Laboratory Tests To Diagnose CDImentioning

confidence: 99%

Clostridioides difficile Infection: Diagnosis and Treatment Challenges

Markantonis,

Fallon,

Madan

et al. 2024

Pathogens

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Clostridioides difficile is the most important cause of healthcare-associated diarrhea in the United States. The high incidence and recurrence rates of C. difficile infection (CDI), associated with high morbidity and mortality, pose a public health challenge. Although antibiotics targeting C. difficile bacteria are the first treatment choice, antibiotics also disrupt the indigenous gut flora and, therefore, create an environment that is favorable for recurrent CDI. The challenge of treating CDI is further exacerbated by the rise of antibiotic-resistant strains of C. difficile, placing it among the top five most urgent antibiotic resistance threats in the USA. The evolution of antibiotic resistance in C. difficile involves the acquisition of new resistance mechanisms, which can be shared among various bacterial species and different C. difficile strains within clinical and community settings. This review provides a summary of commonly used diagnostic tests and antibiotic treatment strategies for CDI. In addition, it discusses antibiotic treatment and its resistance mechanisms. This review aims to enhance our current understanding and pinpoint knowledge gaps in antimicrobial resistance mechanisms in C. difficile, with an emphasis on CDI therapies.

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SEE the DIFFerence: Reducing unnecessary C. difficile orders through clinical decision support in a large, urban safety-net system

Cited by 10 publications

References 20 publications

Implementation of multifaceted diagnostic stewardship for Clostridioides difficile infection during the COVID-19 pandemic at a small Japanese hospital

Implementation of multifaceted diagnostic stewardship for Clostridioides difficile infection during the COVID-19 pandemic at a small Japanese hospital

Tell‐a provider about tele: Reducing overuse of telemetry across 10 hospitals in a safety net system

Clostridioides difficile Infection: Diagnosis and Treatment Challenges

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