Peaper David R, Rathod Shardul N, Sussman L Scott, Azar Marwan M, Murdzek Christina, Roberts Scott C, Tichy Eric M, Topal Jeffrey E, Kashyap Nitu, McManus Dayna, Martinello Richard A
Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA.
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
Infect Control Hosp Epidemiol. 2025 Mar 13;46(5):1-7. doi: 10.1017/ice.2025.30.
To better understand clinicians' rationale for ordering testing for infection (CDI) for patients receiving laxatives and the impact of the implementation of a clinical decision support (CDS) intervention.
A mixed-methods, case series was performed from March 2, 2017 to December 31, 2018.
Yale New Haven Hospital, a 1,541 bed tertiary academic medical center.
Hospitalized patients ≥ 18 years old, and clinicians who were alerted by the CDS.
CDS was triggered in real-time when a clinician sought to order testing for CDI for a patient who received one or more doses of laxatives within the preceding 24 hours.
A total of 3,376 CDS alerts were triggered during the 21-month study period from 2,567 unique clinician interactions. Clinicians bypassed the CDS alert 74.5% of the time, more frequent among residents (48.3% bypass vs. 39.9% accept) and advanced practice providers (APPs) (34.9% bypass vs. 30.6% accept) than attendings (11.3% bypass vs. 22.5% accept). Ordering clinicians noted increased stool frequency/output (48%), current antibiotic exposure (34%), and instructions by an attending physician to test (28%) were among the most common reasons for overriding the alert and proceeding with testing for CDI.
Testing for CDI despite patient laxative use was associated with an increased clinician concern for CDI, patient risk for CDI, and attending physician instruction for testing. Attendings frequently accepted CDS guidance while residents and APPs often reinstated CDI test orders, suggesting a need for greater empowerment and discretion when ordering tests.
为了更好地理解临床医生对接受泻药治疗的患者进行艰难梭菌感染（CDI）检测的理由，以及临床决策支持（CDS）干预措施实施的影响。
于2017年3月2日至2018年12月31日进行了一项混合方法的病例系列研究。
耶鲁纽黑文医院，一家拥有1541张床位的三级学术医疗中心。
年龄≥18岁的住院患者，以及收到CDS提醒的临床医生。
当临床医生试图为在过去24小时内接受过一剂或多剂泻药治疗的患者开具CDI检测医嘱时，CDS会实时触发。
在为期21个月的研究期间，从2567次独特的临床医生互动中总共触发了3376次CDS提醒。临床医生在74.5%的情况下绕过了CDS提醒，住院医师（48.3%绕过vs.39.9%接受）和高级实践提供者（APPs）（34.9%绕过vs.30.6%接受）比主治医生（11.3%绕过vs.22.5%接受）更频繁地绕过提醒。开具医嘱的临床医生指出，大便频率/量增加（48%）、当前使用抗生素（34%）以及主治医生指示进行检测（28%）是最常见的绕过提醒并继续进行CDI检测的原因。
尽管患者使用了泻药仍进行CDI检测与临床医生对CDI的更高关注、患者发生CDI的风险以及主治医生的检测指示有关。主治医生经常接受CDS指导，而住院医师和APPs则经常恢复CDI检测医嘱，这表明在开具检测医嘱时需要更大的自主权和判断力。
