Clinical decision support for gastrointestinal panel testing
Abstract Objective: This study aimed to assess the impact of clinical decision support (CDS) to improve ordering of multiplex gastrointestinal polymerase chain reaction (PCR) testing panel (“GI panel”). Design: Single-center, retrospective, before-after study. Setting: Tertiary care Veteran’s...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2024-01-01
|
| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X24000159/type/journal_article |
| _version_ | 1797320797689217024 |
|---|---|
| author | Nadia T. Saif Cara Dooley Jonathan D. Baghdadi Daniel J. Morgan KC Coffey |
| author_facet | Nadia T. Saif Cara Dooley Jonathan D. Baghdadi Daniel J. Morgan KC Coffey |
| author_sort | Nadia T. Saif |
| collection | DOAJ |
| description |
Abstract
Objective:
This study aimed to assess the impact of clinical decision support (CDS) to improve ordering of multiplex gastrointestinal polymerase chain reaction (PCR) testing panel (“GI panel”).
Design:
Single-center, retrospective, before-after study.
Setting:
Tertiary care Veteran’s Affairs (VA) Medical Center provides inpatient, outpatient, and residential care.
Patients:
All patients tested with a GI panel between June 22, 2022 and April 20, 2023.
Intervention:
We designed a CDS questionnaire in the electronic medical record (EMR) to guide appropriate ordering of the GI panel. A “soft stop” reminder at the point of ordering prompted providers to confirm five appropriateness criteria: 1) documented diarrhea, 2) no recent receipt of laxatives, 3) C. difficile is not the leading suspected cause of diarrhea, 4) time period since a prior test is >14 days or prior positive test is >4 weeks and 5) duration of hospitalization <72 hours. The CDS was implemented in November 2022.
Results:
Compared to the pre-implementation period (n = 136), fewer tests were performed post-implementation (n = 92) with an IRR of 0.61 (p = 0.003). Inappropriate ordering based on laxative use or undocumented diarrhea decreased (IRR 0.37, p = 0.012 and IRR 0.25, p = 0.08, respectively). However, overall inappropriate ordering and outcome measures did not significantly differ before and after the intervention.
Conclusions:
Implementation of CDS in the EMR decreased testing and inappropriate ordering based on use of laxatives or undocumented diarrhea. However, inappropriate ordering of tests overall remained high post-intervention, signaling the need for continued diagnostic stewardship efforts.
|
| first_indexed | 2024-03-08T04:48:12Z |
| format | Article |
| id | doaj.art-ea71ccce28e646e2859abe62f3e138a4 |
| institution | Directory Open Access Journal |
| issn | 2732-494X |
| language | English |
| last_indexed | 2024-03-08T04:48:12Z |
| publishDate | 2024-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj.art-ea71ccce28e646e2859abe62f3e138a42024-02-08T08:21:16ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2024-01-01410.1017/ash.2024.15Clinical decision support for gastrointestinal panel testingNadia T. Saif0Cara Dooley1https://orcid.org/0009-0009-9651-7955Jonathan D. Baghdadi2https://orcid.org/0000-0002-2442-0654Daniel J. Morgan3KC Coffey4https://orcid.org/0009-0003-1548-7202Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USADepartment of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USADepartment of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USADepartment of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA Department of Medicine, Veteran’s Affairs (VA) Maryland Healthcare System, Baltimore, MD, USADepartment of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA Department of Medicine, Veteran’s Affairs (VA) Maryland Healthcare System, Baltimore, MD, USA Abstract Objective: This study aimed to assess the impact of clinical decision support (CDS) to improve ordering of multiplex gastrointestinal polymerase chain reaction (PCR) testing panel (“GI panel”). Design: Single-center, retrospective, before-after study. Setting: Tertiary care Veteran’s Affairs (VA) Medical Center provides inpatient, outpatient, and residential care. Patients: All patients tested with a GI panel between June 22, 2022 and April 20, 2023. Intervention: We designed a CDS questionnaire in the electronic medical record (EMR) to guide appropriate ordering of the GI panel. A “soft stop” reminder at the point of ordering prompted providers to confirm five appropriateness criteria: 1) documented diarrhea, 2) no recent receipt of laxatives, 3) C. difficile is not the leading suspected cause of diarrhea, 4) time period since a prior test is >14 days or prior positive test is >4 weeks and 5) duration of hospitalization <72 hours. The CDS was implemented in November 2022. Results: Compared to the pre-implementation period (n = 136), fewer tests were performed post-implementation (n = 92) with an IRR of 0.61 (p = 0.003). Inappropriate ordering based on laxative use or undocumented diarrhea decreased (IRR 0.37, p = 0.012 and IRR 0.25, p = 0.08, respectively). However, overall inappropriate ordering and outcome measures did not significantly differ before and after the intervention. Conclusions: Implementation of CDS in the EMR decreased testing and inappropriate ordering based on use of laxatives or undocumented diarrhea. However, inappropriate ordering of tests overall remained high post-intervention, signaling the need for continued diagnostic stewardship efforts. https://www.cambridge.org/core/product/identifier/S2732494X24000159/type/journal_article |
| spellingShingle | Nadia T. Saif Cara Dooley Jonathan D. Baghdadi Daniel J. Morgan KC Coffey Clinical decision support for gastrointestinal panel testing Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Clinical decision support for gastrointestinal panel testing |
| title_full | Clinical decision support for gastrointestinal panel testing |
| title_fullStr | Clinical decision support for gastrointestinal panel testing |
| title_full_unstemmed | Clinical decision support for gastrointestinal panel testing |
| title_short | Clinical decision support for gastrointestinal panel testing |
| title_sort | clinical decision support for gastrointestinal panel testing |
| url | https://www.cambridge.org/core/product/identifier/S2732494X24000159/type/journal_article |
| work_keys_str_mv | AT nadiatsaif clinicaldecisionsupportforgastrointestinalpaneltesting AT caradooley clinicaldecisionsupportforgastrointestinalpaneltesting AT jonathandbaghdadi clinicaldecisionsupportforgastrointestinalpaneltesting AT danieljmorgan clinicaldecisionsupportforgastrointestinalpaneltesting AT kccoffey clinicaldecisionsupportforgastrointestinalpaneltesting |