{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T15:42:29Z","timestamp":1790091749614,"version":"4.0.1"},"reference-count":21,"publisher":"Cambridge University Press (CUP)","issue":"8","license":[{"start":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T00:00:00Z","timestamp":1678924800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X22002549_as1\"><jats:title>Background:<\/jats:title><jats:p>Ordering Clostridioides difficile diagnostics without appropriate clinical indications can result in inappropriate antibiotic prescribing and misdiagnosis of hospital onset <jats:italic>C. difficile<\/jats:italic> infection. Manual processes such as provider review of order appropriateness may detract from other infection control or antibiotic stewardship activities.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X22002549_as2\"><jats:title>Methods:<\/jats:title><jats:p>We developed an evidence-based clinical algorithm that defined appropriateness criteria for testing for <jats:italic>C. difficile<\/jats:italic> infection. We then implemented an electronic medical record\u2013based order-entry tool that utilized discrete branches within the clinical algorithm including history of prior <jats:italic>C. difficile<\/jats:italic> test results, laxative or stool-softener administration, and documentation of unformed bowel movements. Testing guidance was then dynamically displayed with supporting patient data. We compared the rate of completed <jats:italic>C. difficile<\/jats:italic> tests after implementation of this intervention at 5 hospitals to a historic baseline in which a best-practice advisory was used.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X22002549_as3\"><jats:title>Results:<\/jats:title><jats:p>Using mixed-effects Poisson regression, we found that the intervention was associated with a reduction in the incidence rate of both <jats:italic>C. difficile<\/jats:italic> ordering (incidence rate ratio [IRR], 0.74; 95% confidence interval [CI], 0.63\u20130.88; P = .001) and <jats:italic>C. difficile<\/jats:italic>\u2013positive tests (IRR, 0.83; 95% CI, 0.76\u20130.91; P &lt; .001). On segmented regression analysis, we identified a sustained reduction in orders over time among academic hospitals and a new reduction in orders over time among community hospitals.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X22002549_as4\"><jats:title>Conclusions:<\/jats:title><jats:p>An evidence-based dynamic order panel, integrated within the electronic medical record, was associated with a reduction in both <jats:italic>C. difficile<\/jats:italic> ordering and positive tests in comparison to a best practice advisory, although the impact varied between academic and community facilities.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2022.254","type":"journal-article","created":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T14:52:46Z","timestamp":1678978366000},"page":"1294-1299","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":6,"title":["<i>Clostridioides difficile<\/i> dynamic electronic order panel, an effective automated intervention to reduce inappropriate inpatient ordering"],"prefix":"10.1017","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5723-3927","authenticated-orcid":false,"given":"Matthew J.","family":"Ziegler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia J.","family":"Flores","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mika","family":"Epps","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Hopkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurel","family":"Glaser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1411-7416","authenticated-orcid":false,"given":"Nikhil K.","family":"Mull","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5295-0046","authenticated-orcid":false,"given":"David A.","family":"Pegues","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2023,3,16]]},"reference":[{"key":"S0899823X22002549_ref1","doi-asserted-by":"crossref","first-page":"2887","DOI":"10.1128\/JCM.00891-11","article-title":"Impact of clinical symptoms on interpretation of diagnostic assays for Clostridium difficile infections","volume":"49","author":"Dubberke","year":"2011","journal-title":"J Clin Microbiol"},{"key":"S0899823X22002549_ref6","doi-asserted-by":"crossref","DOI":"10.1007\/s11908-020-0715-4","article-title":"The role of diagnostic stewardship in Clostridioides difficile testing: challenges and opportunities","volume":"22","author":"Boly","year":"2020","journal-title":"Curr Infect Dis Rep"},{"key":"S0899823X22002549_ref16","doi-asserted-by":"crossref","first-page":"S144","DOI":"10.1093\/ajcp\/aqy112.343","article-title":"Failure of best practice alerts to affect C. difficile test utilization","volume":"1","author":"Swimley","year":"2018","journal-title":"Am J Clin Pathol"},{"key":"S0899823X22002549_ref3","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/cix1085","article-title":"Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)","volume":"66","author":"McDonald","year":"2018","journal-title":"Clin Infect Dis"},{"key":"S0899823X22002549_ref4","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.ajic.2017.10.011","article-title":"National Healthcare Safety Network laboratory-identified Clostridium difficile event reporting: a need for diagnostic stewardship","volume":"46","author":"Rock","year":"2018","journal-title":"Am J Infect Control"},{"key":"S0899823X22002549_ref11","doi-asserted-by":"crossref","first-page":"2745","DOI":"10.1128\/JCM.00968-15","article-title":"Reducing unnecessary and duplicate ordering for ovum and parasite examinations and Clostridium difficile PCR in immunocompromised patients by using an alert at the time of request in the order management system","volume":"53","author":"Otto","year":"2015","journal-title":"J Clin Microbiol"},{"key":"S0899823X22002549_ref10","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1017\/ice.2017.16","article-title":"The use of a computerized provider order-entry alert to decrease rates of Clostridium difficile testing in young pediatric patients","volume":"38","author":"Nicholson","year":"2017","journal-title":"Infect Control Hosp Epidemiol"},{"key":"S0899823X22002549_ref17","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1136\/bmjqs-2018-008454","article-title":"Using a 10-step framework to support the implementation of an evidence-based clinical pathways programme","volume":"28","author":"Flores","year":"2019","journal-title":"BMJ Qual Saf"},{"key":"S0899823X22002549_ref8","doi-asserted-by":"crossref","first-page":"3872","DOI":"10.1128\/JCM.01724-13","article-title":"Alerting physicians during electronic order entry effectively reduces unnecessary repeat PCR testing for Clostridium difficile","volume":"51","author":"Luo","year":"2013","journal-title":"J Clin Microbiol"},{"key":"S0899823X22002549_ref18","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s13012-015-0209-1","article-title":"A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project","volume":"10","author":"Powell","year":"2015","journal-title":"Implement 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2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}