title: Reducing Overutilization of Testing for Clostridium difficile Infection in a Pediatric Hospital System: A Quality Improvement Initiative.
abstract: OBJECTIVE
  Study objectives included addressing overuse of Clostridium difficile laboratory testing by decreasing submission rates of nondiarrheal stool specimens and specimens from children ≤12 months of age and determining resultant patient and laboratory cost savings associated with decreased testing.
  
  
  METHODS
  A multifaceted initiative was developed, and components included multiple provider education methods, computerized order entry modifications, and automatic declination from laboratory on testing stool specimens of nondiarrheal consistency and from children ≤12 months old. A run chart, demonstrating numbers of nondiarrheal plus infant stool specimens submitted over time, was developed to analyze the initiative's impact on clinicians' test-ordering practices. A p-chart was generated to evaluate the percentage of these submitted specimens tested biweekly over a 12-month period. Cost savings for patients and the laboratory were assessed at the study period's conclusion.
  
  
  RESULTS
  Run chart analysis revealed an initial shift after the interventions, suggesting a temporary decrease in testing submission; however, no sustained differences in numbers of specimens submitted biweekly were observed over time. On the p-chart, the mean percentage of specimens tested before the intervention was 100%. After the intervention, the average percentage of specimens tested dropped to 53.8%. Resultant laboratory cost savings totaled nearly $3600, and patient savings on testing charges were ∼$32 000.
  
  
  CONCLUSIONS
  Automatic laboratory declination of nondiarrheal stools submitted for CDI testing resulted in a sustained decrease in the number of specimens tested, resulting in significant laboratory and patient cost savings. Despite multiple educational efforts, no sustained changes in physician ordering practices were observed.
authors.affiliation: Department of Pediatrics, Baystate Medical Center and Tufts University School of Medicine, Springfield, Massachusetts; and james.klattemd@baystatehealth.org.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Klatte
authors.affiliation: Children's Mercy Hospital and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: Rangaraj
authors.initials: R
authors.lastname: Selvarangan
authors.affiliation: Children's Mercy Hospital and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Jackson
authors.affiliation: Children's Mercy Hospital and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: Angela L
authors.initials: AL
authors.lastname: Myers
mesh_terms: D002648:Child; D064790:Clinical Laboratory Services / Q000191:economics / Q000706:statistics & numerical data; D016360:Clostridioides difficile / Q000302:isolation & purification*; D017046:Cost Savings / Q000379:methods / Q000706:statistics & numerical data; D004469:Economics, Hospital; D005243:Feces / Q000382:microbiology*; D006776:Hospitals, Pediatric / Q000592:standards; D006801:Humans; D008828:Microbiological Techniques / Q000191:economics / Q000379:methods; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D019564:Unnecessary Procedures / Q000191:economics / Q000706:statistics & numerical data