-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/59819e43297d7d8b020264b5444d8f9b.pdf?Expires=1712793600&Signature=Nr4XBw4ti0b-5JUqNwBY4RKvuHjgrO-Losra%7EAZS295Cwd6VyL6k3UZEd5FYVj-Bw8jiMVYagXSbnZ0nP0Lo6Ly9QCeEzWOAHbXqNdwxKX89rUrbl8H5k6YLuIxnig6MU%7E4tCD%7EWlkfujZGax8aSd8fxspN6l7aimoXkeXVhdY9cZ%7E0BPQk1PFdYEgpcrSI3sOmPgNgHErz2%7Ewclcyc4V7jF0lUriCwQSXcakl7uVRbaozBtugbIT0uWyfe68MBKLD8-neNtNfTSWyMRLAEEs3cZ1pAUvIgzaxEml1vuPl14MSnVjfnzhjS9twh3T0wmSpzxQy%7EPgK3tdeE5Z3UmUA__&Key-Pair-Id=K6UGZS9ZTDSZM
bddd4dfb54f8fbd56c6ccf3286fe5269
PDF Text
Text
Use of Academic Detailing for Clostridioides difficile Diagnostic Stewardship
Ahmed Abdul Azim MD, Preeti Mehrotra MD MPH, Sharon B. Wright MD MPH
Introduction/Problem
Academic detailing (AD) is an educational outreach tool used to conduct two-way
communication with clinicians to assess baseline knowledge and motivations for certain
practices1. Our institution noted an increase in Clostridioides difficile (C. diff) positive test
results, raising concern for over-testing. The Infectious Diseases Society of America (IDSA)
and our hospital guidelines recommend C. diff testing (CDT) if a patient has ≥ 3 loose stools
in 24 hours2. Some institutions use electronic clinical decision support tools to decrease
inappropriate CDT3. We ran a pilot QI project using AD to improve appropriateness in CDT.
This was done with the aim to deliver the results of the pilot to IS to develop a POE-based
solution for providing educational and patient-specific information at the time of CDT order.
Aim/Goal
1. Use AD to improve appropriateness of CDT based on current guideline recommendations
in order to reduce over-testing and reduce both publicly reported C. diff infections and
potential overtreatment of patients.
2. Assess baseline knowledge and attitudes of providers towards AD in diagnostic
stewardship for CDT
Timeframe for pilot was 6 months.
The Team
➢
➢
➢
➢
➢
Infection Control/Hospital Epidemiology
Antimicrobial Stewardship
C. difficile Reduction Taskforce
Hospital Medicine
Medicine Residents
TAP TO GO
BACK TO
KIOSK MENU
The Interventions
•
•
Study period: Select weekdays in Nov-Dec 2018 and Mar 2019
Study population: Resident/teaching attending or hospitalist-only teams caring for
patients on the inpatient Medicine service. We excluded clinicians of patients with
immunocompromised patients and providers of patients with results CDT order by a
different provider.
•
AD was delivered one-on-one with each included clinician to:
•
Discuss appropriateness of the CDT on their respective patient(s)
•
Assess baseline knowledge on the appropriate indications for CDT
•
Assess the clinician’s attitude towards CDT diagnostic stewardship
Methods/ Definitions
• Aim 1: Determination of CDT appropriateness
o Definition of appropriate CDT
▪ ≥3 loose stools in 24 hours
AND
▪ No laxatives for 24 hours prior to CDT
OR
▪ Clinical syndrome consistent with C. diff infection (≥1 of the following):
− Unexplained leukocytosis
− Fevers
− Colitis/ileus on abdominal imaging
• Aim 2: AD delivered on CDT (face-to-face or by phone)
o Knowledge assessment: “Are you aware of the indications for appropriate CDT put forth by
the IDSA or our hospital policy?”
o Attitudes assessment:
▪ “Did you find this peer-to-peer discussion geared towards improving diagnostic
stewardship helpful?”
▪ “Do you believe an electronic decision support tool that includes current laxative order
alerts and testing algorithm could impact your decision on CDT ordering?”
For more information, contact:
Ahmed Abdul Azim MD, aabdul@bidmc.harvard.edu
�Use of Academic Detailing for Clostridioides difficile Diagnostic Stewardship
Ahmed Abdul Azim MD, Preeti Mehrotra MD MPH, Sharon B. Wright MD MPH
More Results/Progress to Date
Figure: Study Cohort and C. difficile Testing (CDT) Appropriateness
➢ Aim 1
• Overall, 7/23 (30%) of CDT were considered inappropriate
o All inappropriate tests were canceled following AD
o 3/7 (43%) canceled CDT after AD highlighted prior test pending and/or resolution of loose
stools
➢ Aim 2
• All clinicians receiving AD described it as helpful
• Examples of feedback:
o An internal medicine resident felt this would inform their future CDT ordering practices
o A hospitalist appreciated discussing C. diff diagnostic stewardship with an infectious diseases
clinician
• 14/15 (93%) of clinicians felt that an electronic clinical decision support tool would be a helpful
alternative to AD
Lessons Learned
1. In our limited sample, academic detailing improved appropriateness of C. diff testing
2. Academic detailing was well accepted by clinicians, mirroring antimicrobial stewardship
experiences
3. Electronic decision support and timeouts for C. diff orders may be resource-sparing options for
diagnostic stewardship
Next Steps
•
Work with C. difficile Reduction Taskforce to develop a proposal for an electronic clinical
decision support tool for submission to BIDMC Information Services to include:
•
cPOE algorithm for C. diff diagnostic stewardship to improve appropriateness of
CDT
•
CDT electronic order “timeout” 24 hours post order if not yet collected
For more information, contact:
Ahmed Abdul Azim MD, aabdul@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Ahmed Abdul Azim (<a href="mailto:aabdul@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">aabdul@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Infection Control / Hospital Epidemiology
Hospital Medicine
Infectious Disease
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Ahmed Abdul Azim
Preeti Mehrotra
Sharon B. Wright
C. difficile Reduction Taskforce
Antimicrobial Stewardship
Medicine Residents
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Use of Academic Detailing for Clostridioides difficile Diagnostic Stewardship
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Safety