Prescriber Behavior in Clostridioides difficile Testing: A 3-Hospital Diagnostic Stewardship Intervention

Masako Mizusawa; Bryce A Small; Yea-Jen Hsu; Sima L Sharara; Edina Advic; Christopher Kauffman; Aaron M Milstone; Leonard Feldman; Amit K Pahwa; Julie B Trivedi; Mark B Landrum; Lisa L Maragakis; Karen C Carroll; Sara E Cosgrove; Clare Rock

doi:10.1093/cid/ciz295

Prescriber Behavior in Clostridioides difficile Testing: A 3-Hospital Diagnostic Stewardship Intervention

Clin Infect Dis. 2019 Nov 13;69(11):2019-2021. doi: 10.1093/cid/ciz295.

Authors

Masako Mizusawa¹, Bryce A Small², Yea-Jen Hsu³, Sima L Sharara⁴, Edina Advic⁵, Christopher Kauffman⁶, Aaron M Milstone^{7

8

9}, Leonard Feldman^{10

11}, Amit K Pahwa^{10

11}, Julie B Trivedi^{4

12}, Mark B Landrum¹³, Lisa L Maragakis^{4

8

14}, Karen C Carroll¹⁵, Sara E Cosgrove^{4

8

14}, Clare Rock^{4

8

14}

Affiliations

¹ Section of Infectious Diseases, Department of Internal Medicine, University of Missouri Kansas City, Missouri.
² Johns Hopkins University School of Medicine, Baltimore, Maryland.
³ Health Policy and Management, Johns Hopkins Bloomberg School of Public Health.
⁴ Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine.
⁵ Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland.
⁶ Johns Hopkins Health System, Baltimore, Maryland.
⁷ Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine.
⁸ Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine.
⁹ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health.
¹⁰ Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine.
¹¹ Division of General Internal Medicine, Department of Internal Medicine, Johns Hopkins University School of Medicine.
¹² Department of Infection Prevention and Control, Suburban Hospital, Bethesda, Maryland.
¹³ Infectious Diseases and Hospital Epidemiology and Infection Control, Howard County General Hospital, Columbia, Maryland.
¹⁴ Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital.
¹⁵ Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine.

PMID: 31125399
DOI: 10.1093/cid/ciz295

Abstract

Computerized clinical decision support (CCDS) significantly reduced Clostridioides difficile testing at 3 hospitals; from 12.6 to 9.5, from 10.1 to 6.4, and from 14.0 to 9.6 average weekly tests per 1000 inpatient days. There were no related adverse events. Senior providers were more likely than interns or residents to follow CCDS.

Keywords: C. difficile; computerized clinical decision support; diagnostic stewardship intervention; provider behavior.

Publication types

Research Support, U.S. Gov't, P.H.S.

MeSH terms

Algorithms
Anti-Bacterial Agents / administration & dosage
Clostridioides difficile / pathogenicity*
Clostridium Infections / diagnosis*
Decision Support Systems, Clinical*
Diagnostic Tests, Routine / statistics & numerical data
Hospitals / statistics & numerical data
Humans
Inpatients / statistics & numerical data

Substances

Anti-Bacterial Agents

Grants and funding

U01 CK000554/CK/NCEZID CDC HHS/United States