2082. Real-Time Clinical Data Tracking Enables Enforcement of Diarrhea and Absence of Laxatives in Hospitalized Patients Undergoing Clostridium difficile Testing
Session: Poster Abstract Session: Clostridium difficile: Outcomes, Testing, Prevention
Saturday, October 29, 2016
Room: Poster Hall

Background: Health care providers often test and treat patients for Clostridium difficile infection in the absence of diarrhea. Our objective was to develop and apply a real-time data tracking tool to restrict Clostridium difficile testing to patients with diarrhea and an absence of laxative therapy.

Methods: A real-time electronic medical chart (EMR) report, displaying bowel movement occurrence and consistency and laxative administration was developed and implemented in the EMR.  From 6/22/15 to 3/27/16, upon receipt of stool samples from inpatients, laboratory accessioners used the report to enforce testing criteria, which was defined as presence of 3 or more unformed stool in 24 hours and no laxatives administered in the prior 48 hours.  The efficacy of the intervention was assessed as a measure of laboratory non-compliance with criteria per 4-week period. CDI-associated complications were evaluated in patients that did not meet testing criteria but whose stool samples were tested under a research protocol.

Results: Between 6/22/15 and 3/27/16, 561 (31.7%) of 1769 C. difficile test orders were rejected due to any reason of which 132 (23.5%) and 183 (32.6%) were due to <3 unformed stool in 24 hours and laxatives in prior 48 hours, respectively. Accessioner’s non-compliance with testing criteria rapidly declined from 35.4% in the 1st 4-week period to 3.4% in the 10th period (Figure 1).  Provider behavior did not improve during the study (Figure 1). CDI-associated complications were not significantly different in rejected patients with positive and negative C. difficile results.

Conclusion: Real-time clinical data tracking was highly effective for reducing inappropriate C. difficile testing in patients without diarrhea. 

Figure 1. Non-compliance with C. difficile testing criteria per 4-week period. Dashed line shows percentage of all C. difficile tests ordered and collected by physician and nurses, respectively, from patients with <3 unformed stool in 24 hours or laxatives in prior 48 hours. Solid line shows percentage of C. difficile orders for patients with <3 unformed stool in 24 hours or laxatives in prior 48 hours that were incorrectly accepted for testing by the laboratory.




Cynthia Truong, BS1, Lee Schroeder, MD, PhD2, Marisa Holubar, MD, MS3, John Shepard, BA, MBA, MHA4, Alexandra Madison, BS, BA, MPH4, Lucy Tompkins, MD, PhD, FSHEA, FIDSA3,4, Neil Shah, MD1 and Niaz Banaei, MD1,3,5, (1)Department of Pathology, Stanford University School of Medicine, Stanford, CA, (2)Department of Pathology, University of Michigan School of Medicine, Ann Arbor, MI, (3)Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, (4)Infection Control and Prevention, Stanford Health Care, Stanford, CA, (5)Clinical Microbiology Laboratory, Stanford University Medical Center, Palo Alto, CA


C. Truong, None

L. Schroeder, None

M. Holubar, None

J. Shepard, None

A. Madison, None

L. Tompkins, None

N. Shah, None

N. Banaei, Karius Inc: Investigator , Research support

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