Fargo VA Healthcare System, Fargo, ND; University of North Dakota, Department of Medicine, Grand Forks, ND.
Palo Alto VA Healthcare System, Palo Alto, CA.
Am J Infect Control. 2023 Oct;51(10):1085-1088. doi: 10.1016/j.ajic.2023.02.017. Epub 2023 May 11.
Clostridioides difficile (C. difficile) is a common hospital-acquired infection which can lead to major implications for patients and our health care system. In this study, we examine a policy change at a single-site Veterans Affairs Healthcare system that allowed bedside nurses to order C. difficile testing in addition to physicians on the time to obtain test results and initiate treatment.
The time to receive results and initiate treatment were analyzed before and after the policy change, and between physicians and nurses using descriptive statistics and paired student t-tests. Variables associated with lower ordering times were also analyzed using logistic regression while adjusting for patient admission location and length of inpatient hospital stay.
The difference in time to obtain the result both before and after the policy change and between ordering provider type were both statistically significant (P < .05). In unadjusted models, nurses were associated with faster test results compared to physicians (OR (95% CI) 1.72 (1.45-2.05).
Allowing bedside nurses more autonomy to order the stool sample significantly decreased the amount of time to receive the results, potentially decreasing the risk of additional infections among patients and decreasing the economic burden on the hospital.
艰难梭菌（C. difficile）是一种常见的医院获得性感染，可能对患者和我们的医疗体系产生重大影响。在这项研究中，我们研究了退伍军人事务医疗系统中一项单一地点的政策变化，该政策允许床边护士与医生一起开艰难梭菌检测，以缩短获得检测结果和开始治疗的时间。
在政策变更前后以及医生和护士之间，使用描述性统计和配对学生 t 检验分析获得结果和开始治疗的时间。使用逻辑回归分析与较低的订单时间相关的变量，同时调整患者入院地点和住院时间长度。
在政策变更前后以及两种开单方式之间，获得结果的时间差异均具有统计学意义（P <.05）。在未调整的模型中，与医生相比，护士开单与更快的检测结果相关（OR（95%CI）1.72（1.45-2.05））。
允许床边护士更多地自主开粪便样本检测单，显著缩短了获得结果的时间，可能降低了患者的额外感染风险，并降低了医院的经济负担。
