ArticleInfection control and hospital epidemiology2020
The impact of an electronic medical record nudge on reducing testing for hospital-onset
Article in Infection control and hospital epidemiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
7 citing papers in PubMed, 24 citations in OpenAlex.
- The impact of the quality improvement program on Clostridioides difficile infection management: a quasi-experimental study.Intestinal research · 2025Article
- The Elements of Style for Interruptive Electronic Health Record Alerts.Applied clinical informatics · 2025Article
- Clinical decision support for gastrointestinal panel testing.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Article
- Diagnostic stewardship to limit repeat plasma cytomegalovirus viral load testing.BMC infectious diseases · 2023Article
- Implementation and Evaluation of Two Nudges in a Hospital's Electronic Prescribing System to Optimise Cost-Effective Prescribing.Healthcare (Basel, Switzerland) · 2022Article
- A Baker's Dozen of Top Antimicrobial Stewardship Intervention Publications in 2020.Open forum infectious diseases · 2021Review
- Reductions in inpatient fluoroquinolone use and postdischargeAntimicrobial stewardship & healthcare epidemiology : ASHE · 2021Article
Corrections and comments
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Authors and funding
10 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveTo determine the effect of an electronic medical record (EMR) nudge at reducing total and inappropriate orders testing for hospital-onset Clostridioides difficile infection (HO-CDI).
designAn interrupted time series analysis of HO-CDI orders 2 years before and 2 years after the implementation of an EMR intervention designed to reduce inappropriate HO-CDI testing. Orders for C. difficile testing were considered inappropriate if the patient had received a laxative or stool softener in the previous 24 hours.
settingFour hospitals in an academic healthcare network. PATIENTS: All patients with a C. difficile order after hospital day 3.
interventionOrders for C. difficile testing in patients administered a laxative or stool softener in <24 hours triggered an EMR alert defaulting to cancellation of the order ("nudge").
resultsOf the 17,694 HO-CDI orders, 7% were inappropriate (8% prentervention vs 6% postintervention; P < .001). Monthly HO-CDI orders decreased by 21% postintervention (level-change rate ratio [RR], 0.79; 95% confidence interval [CI], 0.73-0.86), and the rate continued to decrease (postintervention trend change RR, 0.99; 95% CI, 0.98-1.00). The intervention was not associated with a level change in inappropriate HO-CDI orders (RR, 0.80; 95% CI, 0.61-1.05), but the postintervention inappropriate order rate decreased over time (RR, 0.95; 95% CI, 0.93-0.97).
conclusionAn EMR nudge to minimize inappropriate ordering for C. difficile was effective at reducing HO-CDI orders, and likely contributed to decreasing the inappropriate HO-CDI order rate after the intervention.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.