A mixed-methods study assessing the performance of a clinical decision support tool for Clostridioides difficile testing for patients receiving laxatives.

IF 3 4区 医学 Q2 INFECTIOUS DISEASES
David R Peaper, Shardul N Rathod, L Scott Sussman, Marwan M Azar, Christina Murdzek, Scott C Roberts, Eric M Tichy, Jeffrey E Topal, Nitu Kashyap, Dayna McManus, Richard A Martinello
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引用次数: 0

Abstract

Objective: To better understand clinicians' rationale for ordering testing for C. difficile infection (CDI) for patients receiving laxatives and the impact of the implementation of a clinical decision support (CDS) intervention.

Design: A mixed-methods, case series was performed from March 2, 2017 to December 31, 2018.

Setting: Yale New Haven Hospital, a 1,541 bed tertiary academic medical center.

Participants: Hospitalized patients ≥ 18 years old, and clinicians who were alerted by the CDS.

Intervention: 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.

Results: 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.

Conclusions: 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.

一项混合方法研究评估艰难梭菌测试对接受泻药的患者的临床决策支持工具的性能。
目的:更好地了解临床医生为接受泻药治疗的患者安排艰难梭菌感染(CDI)检测的理由,以及实施临床决策支持(CDS)干预的影响。设计:采用混合方法,于2017年3月2日至2018年12月31日进行病例系列研究。环境:耶鲁大学纽黑文医院,拥有1541张床位的三级学术医疗中心。参与者:≥18岁的住院患者和被CDS提醒的临床医生。干预措施:当临床医生要求对在24小时内服用一剂或多剂泻药的患者进行CDI检测时,CDS被实时触发。结果:在21个月的研究期间,共有3,376个CDS警报被触发,来自2,567个独特的临床医生互动。临床医生绕过CDS警报的比例为74.5%,在住院医师(48.3%对39.9%接受)和高级执业医师(app)(34.9%对30.6%接受)中比在主治医师(11.3%对22.5%接受)中更常见。订购临床医生注意到大便频率/排便量增加(48%)、当前抗生素暴露(34%)和主治医生指示检测(28%)是无视警报并继续进行CDI检测的最常见原因。结论:尽管患者使用泻药,但检测CDI与临床医生对CDI的关注增加、患者发生CDI的风险增加以及主治医生对检测的指导有关。主治医生经常接受CDS指导,而住院医生和app经常恢复CDI测试命令,这表明在订购测试时需要更大的授权和自由裁量权。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.40
自引率
6.70%
发文量
289
审稿时长
3-8 weeks
期刊介绍: Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. Written by infection control practitioners and epidemiologists and guided by an editorial board composed of the nation''s leaders in the field, ICHE provides a critical forum for this vital information.
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