{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:16:27Z","timestamp":1790381787458,"version":"4.1.0"},"reference-count":15,"publisher":"American Society for Microbiology","issue":"12","license":[{"start":{"date-parts":[[2017,12,1]],"date-time":"2017-12-01T00:00:00Z","timestamp":1512086400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            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&amp;P) examinations, and\n            <jats:named-content content-type=\"genus-species\">Giardia<\/jats:named-content>\n            \/\n            <jats:named-content content-type=\"genus-species\">Cryptosporidium<\/jats:named-content>\n            enzyme immunoassay screens (GC-EIA) performed for patients hospitalized &gt;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&amp;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&amp;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\n            <jats:italic>P<\/jats:italic>\n            values were 54.1% for O&amp;P examinations (\n            <jats:italic>P<\/jats:italic>\n            &lt; 0.0001), 22.58% for GC-EIA (\n            <jats:italic>P<\/jats:italic>\n            = 0.2807), and 49.1% for STCUL (\n            <jats:italic>P<\/jats:italic>\n            &lt; 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.\n          <\/jats:p>","DOI":"10.1128\/jcm.01052-17","type":"journal-article","created":{"date-parts":[[2017,9,28]],"date-time":"2017-09-28T00:40:19Z","timestamp":1506559219000},"page":"3350-3354","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":22,"title":["Implementation of a Clinical Decision Support Tool for Stool Cultures and Parasitological Studies in Hospitalized Patients"],"prefix":"10.1128","volume":"55","author":[{"given":"D.","family":"Nikolic","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. S.","family":"Richter","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Asamoto","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Wyllie","sequence":"additional","affiliation":[{"name":"Medical Operations, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Tuttle","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. W.","family":"Procop","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA"},{"name":"Medical Operations, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","article-title":"The meaning of health in the era of value-based care","volume":"9","author":"Balog JE","year":"2017","unstructured":"Balog JE . 2017. The meaning of health in the era of value-based care. Cureus9:e1042.","journal-title":"Cureus"},{"key":"e_1_3_2_3_2","first-page":"5","article-title":"The dream of value-based care","volume":"10","author":"Nash DB","year":"2017","unstructured":"Nash DB . 2017. The dream of value-based care. 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The use and abuse of routine stool microbiology: a College of American Pathologists Q-probes study of 601 institutions. Arch Pathol Lab Med120:206\u2013211.","journal-title":"Arch Pathol Lab Med"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00016-13"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis551"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1309\/AJCPJOJ3HKEBD3TU"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1309\/AJCPOWHOIZBZ3FRW"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmoldx.2015.01.003"}],"container-title":["Journal of Clinical Microbiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/JCM.01052-17","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/JCM.01052-17","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,5]],"date-time":"2022-03-05T09:49:50Z","timestamp":1646473790000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/JCM.01052-17"}},"subtitle":[],"editor":[{"given":"Betty A.","family":"Forbes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2017,12]]},"references-count":15,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2017,12]]}},"alternative-id":["10.1128\/JCM.01052-17"],"URL":"https:\/\/doi.org\/10.1128\/jcm.01052-17","relation":{},"ISSN":["0095-1137","1098-660X"],"issn-type":[{"value":"0095-1137","type":"print"},{"value":"1098-660X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12]]},"assertion":[{"value":"2017-07-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-09-21","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-11-27","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}