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Novel test algorithm reduces unnecessary testing in patients with diarrhoea

Stephen Padilla
09 Feb 2018

A point-of-order test restriction algorithm for hospitalized adults with diarrhoea reduces bacterial stool cultures and ova and parasites testing, which results in substantial cost and time savings, according to a recent study.

“This effect occurred in areas where the advisor was directly employed, as well as in other clinical areas that did not have access to the tool,” researchers said. “The method of test restriction … is different from those described previously, as it directly impacts the provider’s ability to order the studies rather than relying on rejection of already collected specimens that do not meet testing criteria.”

A significant decrease was observed in stool culture and ova and parasites testing rates at the adult inpatient (p=0.001 for both), paediatric (p<0.001 for both) and adult emergency department (p<0.001; p=0.009) locations. The intervention site saw an immediate decrease, while other locations exhibited a delayed but sustained decrease that suggests a collateral impact. [Am J Med 2018;131:193-199.e1]

“The use of a computerized testing advisor to guide clinicians on the appropriate testing for hospitalized patients with diarrhoea led to a significant and immediate reduction in the rate of bacterial stool culture and stool ova and parasites testing in adult inpatients,” researchers said. “This impact was sustained following implementation.”

In the outpatient setting, there was a significant increase in the rate of stool culture (p=0.02) and ova and parasites testing (p=0.001). An estimated $21,931 was saved annually.

“The financial impact of reduced stool testing, while modest at $21,931 a year, is likely underestimated, given that reduced nursing workload, decreased need for collection supplies and a reduction in other indirect costs anticipated as a result of less testing were not included in the analysis,” researchers said.

Putting this in context, an estimated $92,000 was saved annually with a computerized physician order entry-based intervention targeted at reducing redundant B-type natriuretic peptide orders, while another intervention designed to limit repetitive Clostridium difficile testing saved about $21,650 yearly, according to researchers. [BMC Med Inform Decis Mak 2013;13:43; J Clin Microbiol 2013;51:3872-3874]

The estimated cost savings included only the intervention site and might have been higher had the effects seen at the other sites been included, they said.

“Finally, the impact in the reduction of unnecessary antibiotic use and subsequent risk of C. difficile infection and contribution to the development of multidrug-resistant organisms is important to acknowledge, even if this is not able to be quantified,” they added.

Patients with diarrhoea at a tertiary academic medical centre were enrolled. The intervention was a computerized physician order entry-based test guidance algorithm that restricted the use of stool cultures and ova and parasites testing of diarrhoea in the adult inpatient location vs nonintervention sites (ie, emergency department, paediatric inpatient, and adult and paediatric outpatient locations).

Researchers measured stool culture, ova and parasites, and C. difficile testing rates from 1 July 2012 to 31 January 2016. They also calculated advisor usage, consults generated, information accuracy and cost savings.

“In an era of medicine where the reduction of unnecessary treatment and testing is recognized as an important goal, projects such as this are crucial,” researchers said. “Future efforts to expand this work to other health care systems and for the evaluation of other disease states should be considered.”

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Most Read Articles
Stephen Padilla, 2 days ago
Treatment with oral thrombopoietin receptor agonist eltrombopag leads to similar platelet counts in patients with chronic immune thrombocytopaenia (cITP) and persistent (per)ITP, according to the results of phase III (EXTEND) and IV studies presented at the 23rd Congress of the European Hematology Association (EHA 2018) held in Stockholm, Sweden.
Pearl Toh, 4 days ago
Lonely people were twice as likely to die from any cause than people who did not feel lonely, according to a study based on a national survey presented at the recent EuroHeartCare 2018 in Dublin, Ireland. Also, loneliness is associated with poorer patient-reported outcomes in terms of mental and physical health in patients with heart disease.
15 Jun 2018
Higher activity of plasma xanthine oxidase appears to be linked to insulin resistance and liver dysfunction among type 2 diabetes mellitus (T2DM) patients with metabolic syndrome (MetS), according to a recent Japan study.
Jairia Dela Cruz, 2 days ago
A treatment regimen combining daratumumab plus bortezomib, melphalan and prednisone markedly extends progression-free survival in patients with multiple myeloma, inducing deep responses and demonstrating acceptable tolerability regardless of baseline renal function, according to the results of the phase III ALCYONE study.