A RECENT study has demonstrated the effectiveness of an electronic smart order system in reducing inappropriate testing for Clostridioides difficile infection (CDI) within a community healthcare setting at Memorial Healthcare System in Florida, USA.
CDI is a common, potentially serious bacterial infection often arising in healthcare settings and associated with antibiotic overuse. While early diagnosis is crucial, inappropriate testing for CDI increases healthcare onset cases and contributes to overdiagnosis and overtreatment of patients in community healthcare systems. To address this, the team developed and implemented an electronic smart order system designed to ensure that CDI testing was only conducted on patients who met specific clinical criteria, primarily the presence of diarrhoea.
The study reviewed data from 224 patients who underwent CDI testing during the study period: 118 were tested under the new system, and 106 tested before it was implemented. The findings revealed that the rate of inappropriate CDI testing dropped significantly post-implementation, from 31.1% to 11.0% (P<0.001). Additionally, the proportion of patients who met the appropriate testing criteria increased from 61.3% to 80.5% (P=0.002).
However, the study also noted a rise in the rate of 30-day readmissions among patients tested during the post-implementation period, increasing from 33.0% to 54.2% (P=0.001). Researchers suggest that this uptick in readmissions may be linked to the outcomes of patients who had recently undergone gastrointestinal surgery. However, 60-day readmission rates were no longer statistically significant, and the differences in 30-day and 60-day mortality between the two groups were not significant either.
In conclusion, the implementation of the electronic smart order set significantly improved the appropriateness of CDI testing, highlighting the importance of evidence-based guidelines in diagnostic stewardship.
Ada Enesco, EMJ
Reference
Eckardt P et al. Impact of an electronic smart order-set for diagnostic stewardship of Clostridiodes difficile infection (CDI) in a community healthcare system in South Florida. Am J Infect Control. 2024;52(8):893-899.
