Implementation of a Clinical Decision Support Tool for Stool Cultures and Parasitological Studies in Hospitalized Patients
نویسنده :
تاریخ انتشار : 1396/11/12
There is substantial evidence that stool culture and parasitological examinations
are of minimal to no value after 3 days of hospitalization. We implemented and
studied the impact of a clinical decision support tool (CDST) to decrease the number of
unnecessary stool cultures (STCUL), ova/parasite (O&P) examinations, and Giardia/Cryptosporidium
enzyme immunoassay screens (GC-EIA) performed for patients hospitalized 3
days. We studied the frequency of stool studies ordered before or on day 3 and after
day 3 of hospitalization (i.e., categorical orders/total number of orders) before and after
this intervention and denoted the numbers and types of microorganisms detected
within those time frames. This intervention, which corresponded to a custom-programmed
hard-stop alert tool in the Epic hospital information system, allowed providers to
override the intervention by calling the laboratory, if testing was deemed medically necessary.
Comparative statistics were employed to determine significance, and cost savings
were estimated based on our internal costs. Before the intervention, 129/670 (19.25%)
O&P examinations, 47/204 (23.04%) GC-EIA, and 249/1,229 (20.26%) STCUL were ordered
after 3 days of hospitalization. After the intervention, 46/521 (8.83%) O&P examinations,
27/157 (17.20%) GC-EIA, and 106/1,028 (10.31%) STCUL were ordered after 3 days of
hospitalization. The proportions of reductions in the number of tests performed after 3
days and the associated P values were 54.1% for O&P examinations (P 0.0001),
22.58% for GC-EIA (P 0.2807), and 49.1% for STCUL (P 0.0001). This was estimated
to have resulted in $8,108.84 of cost savings. The electronic CDST resulted in a substantial
reduction in the number of evaluations of stool cultures and the number of parasitological
examinations for patients hospitalized for more than 3 days and in a cost savings
while retaining the ability of the clinician to obtain these tests if clinically indicated.