EHR Decision Support Can Reduce Inappropriate GI Testing
Restricting orders cut inappropriate GIPP tests from 21.5 to 4.9 percent for inpatients with diarrhea
MONDAY, April 29, 2019 (Pharmacist's Briefing) -- Electronic health record (EHR) decision support reduces inappropriate use of an expensive gastrointestinal test for patients hospitalized with diarrhea, according to a study published online April 23 in Infection Control & Hospital Epidemiology.
Jasmine R. Marcelin, M.D., from the University of Nebraska Medical Center in Omaha, and colleagues evaluated the impact of a hard stop in the EHR on inappropriate gastrointestinal pathogen panel testing (GIPP). The hard stop prevented clinicians from ordering a GIPP more than one time per admission or in patients hospitalized for more than 72 hours. Comparisons in outcomes were made between patients hospitalized with diarrhea for whom GIPP testing was ordered preimplementation and postimplementation.
The researchers found that before implementation of the hard stop, 1,587 GIPP tests were ordered during 212,212 patient days (7.48 per 1,000 patient days) versus 1,165 GIPP tests during 222,343 patient days (5.24 per 1,000 patient days) postimplementation. These numbers yielded a 30 percent reduction in total GIPP ordering rates between the two periods (relative risk, 0.7). Further, the rate of inappropriate tests ordered decreased from 21.5 to 4.9 percent. Based only on prevented GIPP orders, the total savings triggered by the hard stop were approximately $67,000, with potential savings increasing to $168,000 when silent best-practice alert data were considered.
"We found that when it comes to diarrheal illnesses in the hospital, asking physicians to reconsider if the testing is appropriate through hardwired alerts saves money without compromising quality of care," Marcelin said in a statement.