88 - Impact of a Computerized Clinical Decision Support Tool on clostridioides Difficile Testing and Oral Vancomycin Utilization as a Balancing Metric

Background: Over diagnosis of hospital-onset Clostridioides difficile infection (HO-CDI) is directly tied to inappropriate C. difficile testing which does not distinguish between infected or colonized individuals. This can lead to inappropriate therapy. Multiple studies have utilized Computerized Clinical Decision Support (CCDS) tools to reduce inappropriate C. difficile testing. Our study looks at the impact of a Self-Assessment CCDS tools on C. difficile testing for HO-CDI and oral vancomycin utilization as a balancing metric.

Methods: Our institution utilizes a two-step test to diagnose HO-CDI that consists of toxin A/B enzyme immunoassay followed by a confirmatory PCR. We applied a self-assessment driven CCDS approach to reduce testing for HO-CDI.  Our intervention was deployed in the 3^rd quarter of 2018. It asked 3 questions about stool frequency, laxative use and previous C. difficile testing in the order itself. Inappropriate indications for testing included any of the following: < 3 bowel movements within 24 hours, receipt of a laxative within the past 48 hours, or a previous C. difficile test within the previous 7 days. Ordering providers would self-answer these questions. A ‘yes’ response to any of the three questions prevented further test ordering; though respondents had the freedom to change the answer and still proceed with the test order. We evaluated 3 metrics that were all calculated per 1000 inpatient census days: oral vancomycin usage, HO-CDI rates and C. difficile testing rates.

Results: Compared to baseline, our intervention resulted in a significant reduction of C. difficile testing and HO-CDI rates (Figure 1, Table 1). Oral vancomycin usage also decreased significantly (Figure 2, Table 1).Figure 1. C. difficile testing and Hospital Onset C. difficile Infection Rates by Month, Before and After Intervention
Figure 2. Oral Vancomycin Utilization by Month, Before and After Intervention
Table 1. Changes in Median Rates of C. difficile testing, Hospital Onset C. difficile Infections and Vancomycin Utilization, Before and After Intervention.


Conclusion: Our self-assessment driven CCDS-based diagnostic stewardship resulted in a significant reduction in inappropriate C. difficile testing for HO-CDI and HO-CDI rates. Oral vancomycin utilization as a balancing metric also decreased significantly. This was despite the use of a self-assessment driven approach with the freedom to change the answers in order to proceed with the test order.

Presenting Author(s)

• 

  Cory Hussain, MD

  Infection Prevention
  Denver Health Medical Center
  Denver, CO

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

  Slides Slides and Audio

Co-Author(s)

• DA

  Deborah Aragon, MSPH

  Infection Preventionist
  Denver Health Medical Center
  Denver, Colorado

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Bryan C. Knepper, MPH, MS

  Infection Control Manager
  Denver Health Medical Center
  Denver, CO

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• TJ

  Timothy C. Jenkins, MD

  Associate Professor
  Denver Health Medical Center, University of Colorado School of Medicine
  Denver, Colorado

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Katherine C. Shihadeh, PharmD

  Clinical Pharmacist Specialist, Infectious Diseases
  Denver Health Medical Center
  Denver, Colorado

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• HY

  Heather Young, MD

  Infectious Disease Physician
  Denver Health Medical Center
  Denver, Colorado

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.