2086. Effect of an Electronic Hard-Stop Intervention to Prevent Repeat Clostridium difficile Toxin Testing on Test Utilization and Clinical Outcomes
Session: Poster Abstract Session: Clostridium difficile: Outcomes, Testing, Prevention
Saturday, October 29, 2016
Room: Poster Hall

Background: Although the negative predictive value of Clostridium difficile enzyme immunoassays (CD-EIA) is >97%, repeat orders are frequent. We evaluated the effect of an intervention limiting repeat CD-EIA testing on test utilization and clinical outcomes.

Methods: A hard-stop alert was placed in the computerized physician order entry (CPOE) system denying CD-EIA requests within 96 hours of a previous negative test. If the patient met clinical criteria for high suspicion for C. difficile infection, clinicians could request a repeat test by calling the lab medicine resident and a paper requisition. Education was performed pre-intervention (washout period; excluded from analyses). Testing patterns and clinical outcomes in the 3 months pre- and post-intervention were compared. Univariate logistic regression and chi square analyses were performed.

Results:  The mean number of assays per admit and the number of admissions with assays ordered <96 hours apart decreased significantly post-intervention; the time between assays increased significantly (Table 1, Figure 1). Among patients with ≥1 CD-EIA, there were no significant negative outcomes post-intervention compared to the pre-intervention period (Table 2).

Conclusion: A CPOE system intervention to reduce repeat CD-EIA after an initial negative result within 96 hours resulted in a significant reduction in the number of repeat tests. The intervention did not appear to have a negative effect on patient outcomes.

Table 1. CD-EIAs 3 months pre- and post-intervention

Variable

Pre-intervention

n (%)

Post-intervention

n (%)

p

Total number of EIAs

1525

1203

 

    Positive

93 (6)

86 (7)

0.27

Number of admissions with ≥1 CD-EIA

1146

986

 

    Number of assays per admit (mean [range])

1.42 (1–14)

1.25 (1–6)

<0.01

    Days between 1st and 2nd EIAs (mean [range])

7.6 (0–64)

9.5 (<1–41)

<0.01

    Admissions with EIAs <96 hours apart

124 (11)

15 (2)

<0.01

 

 

 

 

 

 

 

 

 

Table 2. Clinical outcomes 3 months pre- and post-intervention

 

Variable

Pre-intervention

n(%)

Post-intervention

n(%)

OR (95% CI)

p

Discharge location

 

 

 

 

   Home

708 (62)

639 (65)

Ref

 

   Healthcare facility

304 (27)

226 (23)

0.8 (0.7–1.0)

0.06

   Died/hospice

127 (11)

111 (11)

1.0 (0.7–1.3)

0.82

   Unknown

7 (1)

3 (<1)

0.5 (0.1–1.8)

0.28

Died within 30 days of EIA

161 (14)

108 (11)

0.8 (0.6–1.0)

0.04

 

 

Jennie H. Kwon, DO, MSCI1, Kimberly Reske, MPH1, Tiffany Hink, BS2, Ronald Jackups Jr., MD3, Carey-Ann D. Burnham, PhD4 and Erik R. Dubberke, MD, MSPH, FIDSA, FSHEA5, (1)Infectious Diseases, Washington University School of Medicine, St. Louis, MO, (2)Infectious Diseases, Washington University School of Medicine, St Louis, MO, (3)Washington University School of Medicine, SAINT LOUIS, MO, (4)Pathology & Immunology, Washington University, St. Louis, MO, (5)Washington University School of Medicine, St. Louis, MO

Disclosures:

J. H. Kwon, None

K. Reske, None

T. Hink, None

R. Jackups Jr., None

C. A. D. Burnham, None

E. R. Dubberke, Rebiotix Inc.: Investigator and Scientific Advisor , Consulting fee and Research support
Merck: Consultant and Investigator , Consulting fee and Research support
Sanofi Pasteur: Consultant and Grant Investigator , Consulting fee and Grant recipient
Summitt: Consultant , Consulting fee

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