Saif Nadia T, Dooley Cara, Baghdadi Jonathan D, Morgan Daniel J, Coffey K C
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
Department of Medicine, Veteran's Affairs (VA) Maryland Healthcare System, Baltimore, MD, USA.
Antimicrob Steward Healthc Epidemiol. 2024 Feb 8;4(1):e22. doi: 10.1017/ash.2024.15. eCollection 2024.
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").
Single-center, retrospective, before-after study.
Tertiary care Veteran's Affairs (VA) Medical Center provides inpatient, outpatient, and residential care.
All patients tested with a GI panel between June 22, 2022 and April 20, 2023.
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.
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.
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.
本研究旨在评估临床决策支持（CDS）对改善多重胃肠道聚合酶链反应（PCR）检测组合（“GI组合”）医嘱开具情况的影响。
单中心、回顾性前后对照研究。
三级医疗退伍军人事务（VA）医疗中心提供住院、门诊和住院护理服务。
2022年6月22日至2023年4月20日期间所有接受GI组合检测的患者。
我们在电子病历（EMR）中设计了一份CDS问卷，以指导GI组合检测的合理医嘱开具。医嘱开具时的“软停止”提醒促使医生确认五项合理性标准：1）有记录的腹泻；2）近期未使用泻药；3）不是腹泻的主要疑似病因；4）上次检测后时间间隔>14天或上次检测阳性后时间间隔>4周；5）住院时间<72小时。CDS于2022年11月实施。
与实施前阶段（n = 136）相比，实施后进行的检测较少（n = 92），发病率比值比（IRR）为0.61（P = 0.003）。基于泻药使用或无记录腹泻的不适当医嘱开具情况有所减少（IRR分别为0.37，P = 0.012和IRR 0.25，P = 0.08）。然而，干预前后总体不适当医嘱开具情况和结果指标没有显著差异。
在电子病历中实施CDS减少了检测以及基于泻药使用或无记录腹泻的不适当医嘱开具情况。然而，干预后检测的不适当医嘱开具情况总体仍然很高，这表明需要持续进行诊断管理工作。
