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Implementation of a Clinical Decision Support Tool for Stool Cultures and Parasitological Studies in Hospitalized Patients.

Implementation of a Clinical Decision Support Tool for Stool Cultures and Parasitological Studies in Hospitalized Patients.
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Nikolic D, Richter SS, Asamoto K, Wyllie R, Tuttle R, Procop GW,


Nikolic D, Richter SS, Asamoto K, Wyllie R, Tuttle R, Procop GW, (click to view)

Nikolic D, Richter SS, Asamoto K, Wyllie R, Tuttle R, Procop GW,

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Journal of clinical microbiology 2017 09 27() pii JCM.01052-17
Abstract

Background: There is substantial evidence that stool culture and parasitological examinations are of minimal-to-no value after three days of hospitalization. We implemented and studied the impact of a clinical decision support tool (CDST) to decrease unnecessary stool cultures (STCUL), ova/parasite (O&P) exams and Giardia/Cryptosporidium enzyme immunoassay screens (GC-EIA) for patients hospitalized > 3 days.Methods: We studied the frequency of these stool studies ordered ≤ 3days and > 3 days of hospitalization (i.e. categorical orders/total number of orders) before and after this intervention, and denoted the number and types of microorganisms detected within these time frames. This intervention, which was custom programmed hard stop 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.Results: Before the intervention, 129/670 (19.25%) O&P;, 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;, 27/157 (17.20%) GC-EIA, and 106/1,028 (10.31%) STCUL were ordered after 3 days of hospitalization. The percent reduction in tests performed after 3 days and associated p-values were: 54.1% for O&P (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.Conclusion: The electronic CDST resulted in a substantial reduction in the evaluation of stool cultures and parasitological examination for patients hospitalized greater than three days and a cost-savings, while retaining the ability for clinician to obtain these tests if clinically indicated.

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