Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Medical Operations, Cleveland Clinic, Cleveland, Ohio, USA.
J Clin Microbiol. 2017 Dec;55(12):3350-3354. doi: 10.1128/JCM.01052-17. Epub 2017 Sep 27.
There is substantial evidence that stool culture and parasitological examinations are of minimal to no value after 3 days of hospitalization. We implemented and studied the impact of a clinical decision support tool (CDST) to decrease the number of unnecessary stool cultures (STCUL), ova/parasite (O&P) examinations, and / enzyme immunoassay screens (GC-EIA) performed for patients hospitalized >3 days. We studied the frequency of stool studies ordered before or on day 3 and after day 3 of hospitalization (i.e., categorical orders/total number of orders) before and after this intervention and denoted the numbers and types of microorganisms detected within those time frames. This intervention, which corresponded to a custom-programmed hard-stop alert tool in the Epic hospital information system, allowed providers to override the intervention by calling the laboratory, if testing was deemed medically necessary. Comparative statistics were employed to determine significance, and cost savings were estimated based on our internal costs. Before the intervention, 129/670 (19.25%) O&P examinations, 47/204 (23.04%) GC-EIA, and 249/1,229 (20.26%) STCUL were ordered after 3 days of hospitalization. After the intervention, 46/521 (8.83%) O&P examinations, 27/157 (17.20%) GC-EIA, and 106/1,028 (10.31%) STCUL were ordered after 3 days of hospitalization. The proportions of reductions in the number of tests performed after 3 days and the associated values were 54.1% for O&P examinations ( < 0.0001), 22.58% for GC-EIA ( = 0.2807), and 49.1% for STCUL ( < 0.0001). This was estimated to have resulted in $8,108.84 of cost savings. The electronic CDST resulted in a substantial reduction in the number of evaluations of stool cultures and the number of parasitological examinations for patients hospitalized for more than 3 days and in a cost savings while retaining the ability of the clinician to obtain these tests if clinically indicated.
有大量证据表明，住院 3 天后粪便培养和寄生虫检查的价值极小或没有。我们实施并研究了一种临床决策支持工具（CDST）的影响，以减少不必要的粪便培养（STCUL）、卵/寄生虫（O&P）检查和/或酶免疫分析（GC-EIA）的数量，这些检查是为住院时间超过 3 天的患者进行的。我们研究了在干预前后住院第 3 天之前和之后，医嘱中规定的粪便检查的频率（即分类医嘱/总医嘱数），并表示在此期间检测到的微生物数量和类型。该干预措施对应于 Epic 医院信息系统中定制的强制停止警报工具，如果认为检测具有医学必要性，医生可以致电实验室来绕过该干预措施。采用比较统计学来确定显著性，根据我们的内部成本来估计节省的成本。在干预之前，住院 3 天后，有 129/670（19.25%）的 O&P 检查、47/204（23.04%）的 GC-EIA 和 249/1,229（20.26%）的 STCUL 被开出；干预后，住院 3 天后，有 46/521（8.83%）的 O&P 检查、27/157（17.20%）的 GC-EIA 和 106/1,028（10.31%）的 STCUL 被开出。住院 3 天后减少的检测数量及其相关值的比例为：O&P 检查减少 54.1%（<0.0001），GC-EIA 减少 22.58%（=0.2807），STCUL 减少 49.1%（<0.0001）。这估计节省了 8108.84 美元的成本。电子 CDST 大大减少了住院超过 3 天的患者的粪便培养和寄生虫检查数量，并节省了成本，同时保留了临床医生在临床需要时获得这些检查的能力。
