Reduction in Health Care Facility–Onset Clostridioides difficile Infection: A Quality Improvement Initiative

Objective: To reduce health care facility–onset (HCFO) Clostridioides difficile infection (CDI) incidence by improving diagnostic stewardship and reducing the inappropriate testing of C difficile assays. Patients and Methods: A multidisciplinary team conducted a quality improvement initiative from J...

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Autores principales:	Himesh B. Zaver, MD, Varun P. Moktan, MD, Eugene P. Harper, MD, Aman Bali, MD, Ayan Nasir, MD, Carla Foulks, MD, Justin Kuhlman, MD, Max Green, MD, Gillian A. Algan, BS, Heather C. Parth, MPH, Melody Wu-Ballis, BS, Sandra DiCicco, BS, Brenda T. Smith, BS, Ronald N. Owen, BS, Lorraine S. Mai, BS, Sarah L. Spiros, BS, John Griffis, BS, Daphne T. Ramsey Walker, BS, D. Jane Hata, PhD, Justin M. Oring, DO, Harry R. Powers, MD, Wendelyn Bosch, MD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/0803db8cd6264022a6cab137fe652613
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spelling	oai:doaj.org-article:0803db8cd6264022a6cab137fe6526132021-11-12T04:44:25ZReduction in Health Care Facility–Onset Clostridioides difficile Infection: A Quality Improvement Initiative2542-454810.1016/j.mayocpiqo.2021.09.004https://doaj.org/article/0803db8cd6264022a6cab137fe6526132021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2542454821001387https://doaj.org/toc/2542-4548Objective: To reduce health care facility–onset (HCFO) Clostridioides difficile infection (CDI) incidence by improving diagnostic stewardship and reducing the inappropriate testing of C difficile assays. Patients and Methods: A multidisciplinary team conducted a quality improvement initiative from January 1, 2020, through March 31, 2021. Clostridioides difficile infection and inappropriate testing were identified via electronic health records using predefined criteria related to stool quantity/caliber, confounding medications, and laboratory data. An intervention bundle was designed including (1) provider education, (2) implementation of an appropriate testing algorithm, (3) expert review of C difficile orders, and (4) batch testing of assays to facilitate review and cancellation if inappropriate. Results: Compared with a baseline period from January to September 2020, implementation of our intervention bundle from December 2020 to March 2021 resulted in an 83.6% reduction in inappropriate orders tested and a 41.7% reduction in HCFO CDI incidence. Conclusion: A novel prevention bundle improved C difficile diagnostic stewardship and HCFO CDI incidence by reducing testing of inappropriate orders. Such initiatives targeting HCFO CDI may positively affect patient safety and hospital reimbursement.Himesh B. Zaver, MDVarun P. Moktan, MDEugene P. Harper, MDAman Bali, MDAyan Nasir, MDCarla Foulks, MDJustin Kuhlman, MDMax Green, MDGillian A. Algan, BSHeather C. Parth, MPHMelody Wu-Ballis, BSSandra DiCicco, BSBrenda T. Smith, BSRonald N. Owen, BSLorraine S. Mai, BSSarah L. Spiros, BSJohn Griffis, BSDaphne T. Ramsey Walker, BSD. Jane Hata, PhDJustin M. Oring, DOHarry R. Powers, MDWendelyn Bosch, MDElsevierarticleMedicine (General)R5-920ENMayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 5, Iss 6, Pp 1066-1074 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine (General) R5-920
spellingShingle	Medicine (General) R5-920 Himesh B. Zaver, MD Varun P. Moktan, MD Eugene P. Harper, MD Aman Bali, MD Ayan Nasir, MD Carla Foulks, MD Justin Kuhlman, MD Max Green, MD Gillian A. Algan, BS Heather C. Parth, MPH Melody Wu-Ballis, BS Sandra DiCicco, BS Brenda T. Smith, BS Ronald N. Owen, BS Lorraine S. Mai, BS Sarah L. Spiros, BS John Griffis, BS Daphne T. Ramsey Walker, BS D. Jane Hata, PhD Justin M. Oring, DO Harry R. Powers, MD Wendelyn Bosch, MD Reduction in Health Care Facility–Onset Clostridioides difficile Infection: A Quality Improvement Initiative
description	Objective: To reduce health care facility–onset (HCFO) Clostridioides difficile infection (CDI) incidence by improving diagnostic stewardship and reducing the inappropriate testing of C difficile assays. Patients and Methods: A multidisciplinary team conducted a quality improvement initiative from January 1, 2020, through March 31, 2021. Clostridioides difficile infection and inappropriate testing were identified via electronic health records using predefined criteria related to stool quantity/caliber, confounding medications, and laboratory data. An intervention bundle was designed including (1) provider education, (2) implementation of an appropriate testing algorithm, (3) expert review of C difficile orders, and (4) batch testing of assays to facilitate review and cancellation if inappropriate. Results: Compared with a baseline period from January to September 2020, implementation of our intervention bundle from December 2020 to March 2021 resulted in an 83.6% reduction in inappropriate orders tested and a 41.7% reduction in HCFO CDI incidence. Conclusion: A novel prevention bundle improved C difficile diagnostic stewardship and HCFO CDI incidence by reducing testing of inappropriate orders. Such initiatives targeting HCFO CDI may positively affect patient safety and hospital reimbursement.
format	article
author	Himesh B. Zaver, MD Varun P. Moktan, MD Eugene P. Harper, MD Aman Bali, MD Ayan Nasir, MD Carla Foulks, MD Justin Kuhlman, MD Max Green, MD Gillian A. Algan, BS Heather C. Parth, MPH Melody Wu-Ballis, BS Sandra DiCicco, BS Brenda T. Smith, BS Ronald N. Owen, BS Lorraine S. Mai, BS Sarah L. Spiros, BS John Griffis, BS Daphne T. Ramsey Walker, BS D. Jane Hata, PhD Justin M. Oring, DO Harry R. Powers, MD Wendelyn Bosch, MD
author_facet	Himesh B. Zaver, MD Varun P. Moktan, MD Eugene P. Harper, MD Aman Bali, MD Ayan Nasir, MD Carla Foulks, MD Justin Kuhlman, MD Max Green, MD Gillian A. Algan, BS Heather C. Parth, MPH Melody Wu-Ballis, BS Sandra DiCicco, BS Brenda T. Smith, BS Ronald N. Owen, BS Lorraine S. Mai, BS Sarah L. Spiros, BS John Griffis, BS Daphne T. Ramsey Walker, BS D. Jane Hata, PhD Justin M. Oring, DO Harry R. Powers, MD Wendelyn Bosch, MD
author_sort	Himesh B. Zaver, MD
title	Reduction in Health Care Facility–Onset Clostridioides difficile Infection: A Quality Improvement Initiative
title_short	Reduction in Health Care Facility–Onset Clostridioides difficile Infection: A Quality Improvement Initiative
title_full	Reduction in Health Care Facility–Onset Clostridioides difficile Infection: A Quality Improvement Initiative
title_fullStr	Reduction in Health Care Facility–Onset Clostridioides difficile Infection: A Quality Improvement Initiative
title_full_unstemmed	Reduction in Health Care Facility–Onset Clostridioides difficile Infection: A Quality Improvement Initiative
title_sort	reduction in health care facility–onset clostridioides difficile infection: a quality improvement initiative
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/0803db8cd6264022a6cab137fe652613
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Reduction in Health Care Facility–Onset Clostridioides difficile Infection: A Quality Improvement Initiative

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