Reducing Inappropriate Testing for the Evaluation of Diarrhea Among Hospitalized Patients

• Published in: The American journal of medicine Vol. 131; no. 2; pp. 193 - 199.e1
• Main Authors: Tewell, Chad E., Talbot, Thomas R., Nelson, George E., Harris, Bryan D., Jones, Whitney A., Midha, Narinder M., Mulherin, David P., Stephens, Eric B., Thirwani, Anuj, Wright, Patty W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2018
• Subjects: Adult; Advisor; Algorithms; Cost Savings; Cross Infection - diagnosis; Decision Support Techniques; Diarrhea; Diarrhea - microbiology; Diarrhea - parasitology; Hospitalization; Humans; Inappropriate; Interrupted Time Series Analysis; Medical Order Entry Systems - economics; Medical Order Entry Systems - standards; Procedures and Techniques Utilization; Quality Improvement; Retrospective Studies; Testing; Unnecessary; Unnecessary Procedures - statistics & numerical data; Waste; Diarrhea; Advisor; Waste; Inappropriate; Testing; Unnecessary
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2017.10.006

Diarrhea is one of the most common illnesses in the United States. Evaluation frequently does not follow established guidelines. The objective of this study was to evaluate the effectiveness of a computerized physician order entry-based test guidance algorithm with regard to the clinical, financial, and operational impacts. Our population was patients with diarrheal illness at a tertiary academic medical center. The intervention was a computerized physician order entry-based test guidance algorithm that restricted the use of stool cultures and ova and parasites testing of diarrhea in the adult inpatient location vs nonintervention sites, which were the emergency department, pediatric inpatient and adult and pediatric outpatient locations. We measured stool culture, ova and parasites, and Clostridium difficile testing rates from July 1, 2012 to January 31, 2016. Additionally, we calculated advisor usage, consults generated, accuracy of information, and cost savings. There was a significant decrease in stool culture and ova and parasites testing rates at the adult inpatient (P = .001 for both), pediatric (P < .001 for both), and adult emergency department (P < .001; P = .009) locations. The decrease at the intervention site was immediate, whereas the other locations showed a delayed but sustained decrease that suggests a collateral impact. A significant increase in the rate of stool culture and ova and parasites testing was observed in the outpatient setting (P = .02 and P = .001). We estimate that $21,931 was saved annually. A point-of-order test restriction algorithm for hospitalized adults with diarrhea reduced stool testing. Similar programs should be considered at other institutions and for the evaluation of other conditions.