dynamic electronic order panel, an effective automated intervention to reduce inappropriate inpatient ordering.

BACKGROUND

Ordering Clostridioides difficile diagnostics without appropriate clinical indications can result in inappropriate antibiotic prescribing and misdiagnosis of hospital onset infection. Manual processes such as provider review of order appropriateness may detract from other infection control or antibiotic stewardship activities.

METHODS

We developed an evidence-based clinical algorithm that defined appropriateness criteria for testing for infection. We then implemented an electronic medical record-based order-entry tool that utilized discrete branches within the clinical algorithm including history of prior test results, laxative or stool-softener administration, and documentation of unformed bowel movements. Testing guidance was then dynamically displayed with supporting patient data. We compared the rate of completed tests after implementation of this intervention at 5 hospitals to a historic baseline in which a best-practice advisory was used.

RESULTS

Using mixed-effects Poisson regression, we found that the intervention was associated with a reduction in the incidence rate of both ordering (incidence rate ratio [IRR], 0.74; 95% confidence interval [CI], 0.63-0.88; P = .001) and -positive tests (IRR, 0.83; 95% CI, 0.76-0.91; P < .001). On segmented regression analysis, we identified a sustained reduction in orders over time among academic hospitals and a new reduction in orders over time among community hospitals.

CONCLUSIONS

An evidence-based dynamic order panel, integrated within the electronic medical record, was associated with a reduction in both ordering and positive tests in comparison to a best practice advisory, although the impact varied between academic and community facilities.