Clinical decision support for gastrointestinal panel testing.

OBJECTIVE

This study aimed to assess the impact of clinical decision support (CDS) to improve ordering of multiplex gastrointestinal polymerase chain reaction (PCR) testing panel ("GI panel").

DESIGN

Single-center, retrospective, before-after study.

SETTING

Tertiary care Veteran's Affairs (VA) Medical Center provides inpatient, outpatient, and residential care.

PATIENTS

All patients tested with a GI panel between June 22, 2022 and April 20, 2023.

INTERVENTION

We designed a CDS questionnaire in the electronic medical record (EMR) to guide appropriate ordering of the GI panel. A "soft stop" reminder at the point of ordering prompted providers to confirm five appropriateness criteria: 1) documented diarrhea, 2) no recent receipt of laxatives, 3) is not the leading suspected cause of diarrhea, 4) time period since a prior test is >14 days or prior positive test is >4 weeks and 5) duration of hospitalization <72 hours. The CDS was implemented in November 2022.

RESULTS

Compared to the pre-implementation period ( = 136), fewer tests were performed post-implementation ( = 92) with an IRR of 0.61 ( = 0.003). Inappropriate ordering based on laxative use or undocumented diarrhea decreased (IRR 0.37, = 0.012 and IRR 0.25, = 0.08, respectively). However, overall inappropriate ordering and outcome measures did not significantly differ before and after the intervention.

CONCLUSIONS

Implementation of CDS in the EMR decreased testing and inappropriate ordering based on use of laxatives or undocumented diarrhea. However, inappropriate ordering of tests overall remained high post-intervention, signaling the need for continued diagnostic stewardship efforts.