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

被引：17
|
作者：
Howard-Anderson, Jessica R. [1 ]
Sexton, Mary Elizabeth [1 ]
Robichaux, Chad [2 ]
Wiley, Zanthia [1 ]
Varkey, Jay B. [1 ]
Suchindran, Sujit [1 ]
Albrecht, Benjamin [3 ]
Jones, K. Ashley [3 ]
Fridkin, Scott K. [1 ]
Jacob, Jesse T. [1 ]
机构：
[1] Emory Univ, Sch Med, Dept Med, Div Infect Dis, Atlanta, GA 30322 USA
[2] Emory Univ, Dept Med, Sch Med, Atlanta, GA USA
[3] Emory Healthcare, Dept Pharm, Atlanta, GA USA
来源：
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY | 2020年 / 41卷 / 04期
基金：
美国国家卫生研究院;
关键词：
PREVALENCE; RISK;
D O I：
10.1017/ice.2020.12
中图分类号：
R1 [预防医学、卫生学];
学科分类号：
1004 ; 120402 ;
摘要：
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 2 years before and 2 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 had 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 3. Intervention: Orders for C. difficile testing in patients administered a laxative or stool softener in <24 hours triggered an EMR alert defaulting to cancellation of the order ("nudge"). Results: Of the 17,694 HO-CDI orders, 7% were inappropriate (8% prentervention vs 6% postintervention; P < .001). Monthly HO-CDI orders decreased by 21% postintervention (level-change rate ratio [RR], 0.79; 95% confidence interval [CI], 0.73-0.86), and the rate continued to decrease (postintervention 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 postintervention inappropriate order rate decreased over time (RR, 0.95; 95% CI, 0.93-0.97). Conclusion: An EMR nudge to minimize inappropriate ordering for C. difficile was effective at reducing HO-CDI orders, and likely contributed to decreasing the inappropriate HO-CDI order rate after the intervention.
引用
收藏
页码：411 / 417
页数：7
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