Why do clinicians order inappropriate Clostridium difficile testing? An exploratory study

Utilizing a real-time discussion approach to improve the appropriateness of Clostridioides difficile testing and the potential unintended consequences of this strategy

“…The contributors to inappropriate testing were identified in a previous study 7 and through an internal retrospective review of our CDI cases from 2017.…”

“…We also found discrepancies between the stool frequencies documented in the EMR and what the patient or nurse reported to the ordering physician. 7 Such discrepancies were noted in nearly half of the instances of inappropriate testing, which indicates a potential for overtesting.…”

“…The patient's length of stay and prior antibiotic use were the most commonly cited reasons for the perception of high risk, and they were the reasons for testing in 30% of interviews. 7 Thus, any solution needs to consider clinicians' aversion to risk taking when it comes to patient care.…”

“…This process occurred through face-to-face discussions on CDI cases or by phone interviews prompted by the test order. 7 These discussions led to creation of a critical thinking tool with a 'termination plan' that took into account factors associated with high risk of infection, such as those with persistent diarrhea after 24 hours of stopping laxatives and those with signs and symptoms of colitis and toxic megacolon.…”

“…4 Inappropriate documentation of diarrhea therefore poses the risk of inappropriate alerts, and these alerts neither utilize nor assuage the clinician's motivation to avoid patient risk. 7 We hypothesized that an EMR-based 'alert' approach to diagnostic stewardship may not be an effective and sustainable solution for our institution.…”