Three stages of laboratory stewardship in improving appropriate testing in a community-based setting.
Michael S Wang, Gretchen Zimmerman, Theres Klein, Bethany Stibbe, Monica Rykse, Samuel Ballard, Naveen Vijayam, Joe Brown, Khateeb Raza, Shannon Beckman, Andrew M Skinner
Author Information
Michael S Wang: Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA. ORCID
Gretchen Zimmerman: Department of Medicine, Corewell Health Southwest, Saint Joseph, MI, USA.
Theres Klein: Department of Medicine, Corewell Health Southwest, Saint Joseph, MI, USA.
Bethany Stibbe: Department of Medicine, Corewell Health Southwest, Saint Joseph, MI, USA.
Monica Rykse: Department of Medicine, Corewell Health Southwest, Saint Joseph, MI, USA.
Samuel Ballard: Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA.
Naveen Vijayam: Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA.
Joe Brown: Department of Medicine, Corewell Health Southwest, Saint Joseph, MI, USA.
Khateeb Raza: Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA.
Shannon Beckman: Department of Medicine, Corewell Health Southwest, Saint Joseph, MI, USA.
Andrew M Skinner: Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, USA. ORCID
Objective: Assess the efficacy of staged interventions aimed to reduce inappropriate testing and hospital-onset infection (HO-CDI) rates. Design: Interrupted time series. Setting: Community-based. Methods/Interventions: National Healthcare Safety Network (NHSN) metrics from January 2019 to November 2022 were analyzed after three interventions at a community-based healthcare system. Interventions included: (1) an electronic medical record (EMR) based hard stop requiring confirming ���3 loose or liquid stools over 24 h, (2) an infectious diseases (ID) review and approval of testing >3 days of hospital admission, and (3) an infection control practitioner (ICP) reviews combined with switching to a reverse two-tiered clinical testing algorithm. Results: After all interventions, the number of tests per 1,000 patient-days (PD) and HO-CDI cases per 10,000 PD decreased from 20.53 to 6.92 and 9.80 to 0.20, respectively. The EMR hard stop resulted in a (28%) reduction in the CDI testing rate (adjusted incidence rate ratio ((aIRR): 0.72; 95% confidence interval [CI], 0.53 to 0.96)) and ID review resulted in a (42%) reduction in the CDI testing rate (aIRR: 0.58; 95% CI, 0.42-0.79). Changing to the reverse testing algorithm reduced reported HO-CDI rate by (95%) (cIRR: 0.05; 95% CI; 0.01-0.40). Conclusions: Staged interventions aimed at improving diagnostic stewardship were effective in overall reducing CDI testing in a community healthcare system.
References
Clin Infect Dis. 2023 Feb 8;76(3):e34-e41
[PMID: 35997795]
