ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2022
Clinical Decision Support Systems to Reduce Unnecessary Clostridioides difficile Testing Across Multiple Hospitals.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Exploring the role of professional identity in the implementation of clinical decision support systems-a narrative review.Implementation science : IS · 2024Pooled it
- Fungal diagnostic stewardship in immunocompromised populations: a focus on molds and dimorphic fungi.Clinical microbiology reviews · 2026Review
- Healthcare Systems at the Intersection of Just Culture and Artificial Intelligence: Emerging Challenges for Nursing Management.Risk management and healthcare policy · 2026Article
- Diagnostic stewardship - optimization of superficial wound swab cultures can reduce the environmental impact of the microbiology laboratory.Access microbiology · 2025Article
- Approaches to developing and implementing a molecular diagnostics stewardship program for infectious diseases: an ASM Laboratory Practices Subcommittee report.Journal of clinical microbiology · 2024Review
- The foundation for the microbiology laboratory's essential role in diagnostic stewardship: an ASM Laboratory Practices Subcommittee report.Journal of clinical microbiology · 2024Review
- Research agenda for antibiotic stewardship within the Veterans' Health Administration, 2024-2028.Infection control and hospital epidemiology · 2024Article
- Impact of an Intervention Program onOpen forum infectious diseases · 2024Article
- Diagnostic stewardship in infectious diseases: a scoping review.Journal of medical microbiology · 2024Article
- Diagnostic stewardship to improve patient outcomes and healthcare-associated infection (HAI) metrics.Infection control and hospital epidemiology · 2024Article
- The Impact of Pandemic-Driven Care Redesign on Hospital Efficiency.Risk management and healthcare policy · 2024Review
- A decade of clinical microbiology: top 10 advances in 10 years: what every infection preventionist and antimicrobial steward should know.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Review
- Environmental approaches to controlling Clostridioides difficile infection in healthcare settings.Antimicrobial resistance and infection control · 2023Review
- Article
- Diagnostic stewardship forAntimicrobial stewardship & healthcare epidemiology : ASHE · 2023Article
- Leveraging diagnostic stewardship within antimicrobial stewardship programmes.Drugs in context · 2023Review
Corrections and comments
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Authors and funding
21 authors.
Funding
Abstract
backgroundInappropriate Clostridioides difficile testing has adverse consequences for patients, hospitals, and public health. Computerized clinical decision support (CCDS) systems in the electronic health record (EHR) may reduce C. difficile test ordering; however, effectiveness of different approaches, ease of use, and best fit into healthcare providers' (HCP) workflow are not well understood.
methodsNine academic and 6 community hospitals in the United States participated in this 2-year cohort study. CCDS (hard stop or soft stop) triggered when a duplicate C. difficile test order was attempted or if laxatives were recently received. The primary outcome was the difference in testing rates pre- and post-CCDS interventions, using incidence rate ratios (IRRs) and mixed-effect Poisson regression models. We performed qualitative evaluation (contextual inquiry, interviews, focus groups) based on a human factors model. We identified themes using a codebook with primary nodes and subnodes.
resultsIn 9 hospitals implementing hard-stop CCDS and 4 hospitals implementing soft-stop CCDS, C. difficile testing incidence rate (IR) reduction was 33% (95% confidence interval [CI]: 30%-36%) and 23% (95% CI: 21%-25%), respectively. Two hospitals implemented a non-EHR-based human intervention with IR reduction of 21% (95% CI: 15%-28%). HCPs reported generally favorable experiences and highlighted time efficiencies such as inclusion of the patient's most recent laxative administration on the CCDS. Organizational factors, including hierarchical cultures and communication between HCPs caring for the same patient, impact CCDS acceptance and integration.
conclusionsCCDS systems reduced unnecessary C. difficile testing and were perceived positively by HCPs when integrated into their workflow and when displaying relevant patient-specific information needed for decision making.
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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.