924. Case Vignettes to Analyze Physician and Nurse Decision-making regarding Clostridium difficile Infection
Session: Poster Abstract Session: Clostridium difficile Infections: Epidemiology and Diagnostics
Friday, October 9, 2015
Room: Poster Hall
Background: Testing practices for diagnosis of Clostridium difficile infection (CDI) vary widely. Yet there is little data on provider decision-making regarding testing of stool for CDI.

Methods: We undertook a factorial survey depicting hypothetical cases of CDI at the William S. Middleton Memorial Veterans Hospital, a tertiary-care facility affiliated with the University of Wisconsin. Resident physicians (n=20) in all years of training on rotation at the VA hospital and nurses (n=20) on medical-surgical wards comprised the study population. Clinical factors were chosen based on a literature review and preliminary survey of physicians and nurses on 36 CDI risk factors. Five factors selected for inclusion were: hospitalization, fever, stool odor, abdominal exam, and white blood cell count. Participants judged their probability of ordering a CDI diagnostic test and the probability that the patient has CDI on a scale of 0-100% for 20 factor combinations. The cues of a 65 year-old inpatient with two loose stools that day and history of clarithromycin 4 weeks previous were given in all vignettes. Responses were collected anonymously via convenience sampling and analyzed using ordinary linear regression.

Results: The most important factor in residents’ judgment of their likelihood of ordering a test and that the patient had CDI was elevated WBC count, with a 7.9% and 15.3% increased likelihood, respectively. Nurses’ most significant factor was abnormal stool odor, which increased their stated likelihood of testing by 19.5% and stated likelihood that the patient had CDI by 17.6%.

Conclusion: There were differences among resident physicians and nurses’ perceptions regarding the relative importance of factors likely to be associated with a positive test for CDI. For nurses, the presence of a malodorous stool significantly increased their likelihood of testing for CDI.

Nasia Safdar, MD, PhD, FSHEA, Medicine, University of Wisconsin, Madison, WI, Rebekah Blakney, MS, University of Wisconsin, Madison, WI, Robert Wigton, MD, University of Nebraska, Omaha, NE and Eric Yanke, MD, Medicine, WILLIAM S MIDDLETON MEMORIAL VETERANS HOSPITAL, MADISON, WI


N. Safdar, None

R. Blakney, None

R. Wigton, None

E. Yanke, None

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