Methods: To determine which patients had CSD, we designed, educated on and implemented an algorithm to screen for appropriate testing. It required three major elements: three or more loose stools in 24 hours, no gastric motility agents 48 hours prior, and a clinical change in condition (e.g., leukocytosis, fever, abdominal cramping). The completed algorithm accompanied the stool specimen and was required for testing. We evaluated each submitted algorithm for method validation. From this, we determined testing appropriateness and algorithm tool selectivity.
Results: One year pre- and post- algorithm periods (PR-A and PO-A, respectively) were defined. Following its introduction, we noted a 57% decline in rates of HO-CDI (23 cases PR-A vs. 10 cases PO-A), and a 44% reduction in tests sent for C. difficile (average of 41 tests/mo PR-A vs. 23 tests/mo PO-A). We only used NAAT testing. We also noted a marked rise in adherence to the algorithm as time elapsed. The PDSA tool was used to refine the algorithm, with improved utilization by providers.
Conclusion: A simple bedside algorithm leads to more appropriate testing of patients for HO-CDI. A significant decline in reported rates of HO-CDI was noted. There is an additional benefit of diagnostic stewardship, as fewer tests are sent. This tool can be used immediately and independent of an electronic health record, is very cost effective, and is applicable to hospitals with low rates of HO-CDI.
R. V. Nathan,
Merck, Allergan, The Medicines Co:
G. Davis, None