TY - JOUR
T1 - Hardwiring diagnostic stewardship using electronic ordering restrictions for gastrointestinal pathogen testing
AU - Marcelin, Jasmine R.
AU - Brewer, Charlotte
AU - Beachy, Micah
AU - Lyden, Elizabeth
AU - Winterboer, Tammy
AU - Murphy, Caitlin N.
AU - Fey, Paul D.
AU - Hood, Lauren
AU - Van Schooneveld, Trevor C.
N1 - Publisher Copyright:
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Objective: To evaluate the impact of a hard stop in the electronic health record (EHR) on inappropriate gastrointestinal pathogen panel testing (GIPP).Design: We used a quasi-experimental study to evaluate testing before and after the implementation of an EHR alert to stop inappropriate GIPP ordering. Setting: Midwest academic medical center. Participants: Hospitalized patients with diarrhea for which GIPP testing was ordered, between January 2016 through March 2017 (period 1) and April 2017 through June 2018 (period 2).Intervention: A hard stop in the EHR prevented clinicians from ordering a GIPP more than once per admission or in patients hospitalized for >72 hours. Results: During period 1, 1,587 GIPP tests were ordered over 212,212 patient days, at a rate of 7.48 per 1,000 patient days. In period 2, 1,165 GIPP tests were ordered over 222,343 patient days, at a rate of 5.24 per 1,000 patient days. The Poisson model estimated a 30% reduction in total GIPP ordering rates between the 2 periods (relative risk, 0.70; 95% confidence interval [CI], 0.63-0.78; P <.001). The rate of inappropriate tests ordered decreased from 21.5% to 4.9% between the 2 periods (P <.001). The total savings calculated factoring only GIPP orders that triggered the hard stop was ∼$67,000, with potential savings of $168,000 when factoring silent best-practice alert data. Conclusions: A simple hard stop alert in the EHR resulted in significant reduction of inappropriate GIPP testing, which was associated with significant cost savings. Clinicians can practice diagnostic stewardship by avoiding ordering this test more than once per admission or in patients hospitalized >72 hours.
AB - Objective: To evaluate the impact of a hard stop in the electronic health record (EHR) on inappropriate gastrointestinal pathogen panel testing (GIPP).Design: We used a quasi-experimental study to evaluate testing before and after the implementation of an EHR alert to stop inappropriate GIPP ordering. Setting: Midwest academic medical center. Participants: Hospitalized patients with diarrhea for which GIPP testing was ordered, between January 2016 through March 2017 (period 1) and April 2017 through June 2018 (period 2).Intervention: A hard stop in the EHR prevented clinicians from ordering a GIPP more than once per admission or in patients hospitalized for >72 hours. Results: During period 1, 1,587 GIPP tests were ordered over 212,212 patient days, at a rate of 7.48 per 1,000 patient days. In period 2, 1,165 GIPP tests were ordered over 222,343 patient days, at a rate of 5.24 per 1,000 patient days. The Poisson model estimated a 30% reduction in total GIPP ordering rates between the 2 periods (relative risk, 0.70; 95% confidence interval [CI], 0.63-0.78; P <.001). The rate of inappropriate tests ordered decreased from 21.5% to 4.9% between the 2 periods (P <.001). The total savings calculated factoring only GIPP orders that triggered the hard stop was ∼$67,000, with potential savings of $168,000 when factoring silent best-practice alert data. Conclusions: A simple hard stop alert in the EHR resulted in significant reduction of inappropriate GIPP testing, which was associated with significant cost savings. Clinicians can practice diagnostic stewardship by avoiding ordering this test more than once per admission or in patients hospitalized >72 hours.
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U2 - 10.1017/ice.2019.78
DO - 10.1017/ice.2019.78
M3 - Article
C2 - 31012405
AN - SCOPUS:85064925227
SN - 0899-823X
VL - 40
SP - 668
EP - 673
JO - Infection Control and Hospital Epidemiology
JF - Infection Control and Hospital Epidemiology
IS - 6
ER -