title: The Use of a Computerized Provider Order Entry Alert to Decrease Rates of Clostridium difficile Testing in Young Pediatric Patients.
abstract: BACKGROUND Infants and young children are frequently colonized with C. difficile but rarely have symptomatic disease. However, C. difficile testing remains prevalent in this age group. OBJECTIVE To design a computerized provider order entry (CPOE) alert to decrease testing for C. difficile in young children and infants. DESIGN An interventional age-targeted before-after trial with comparison group SETTING Monroe Carell Jr. Children's Hospital at Vanderbilt University, Nashville, Tennessee. PATIENTS All children seen in the inpatient or emergency room settings from July 2012 through July 2013 (pre-CPOE alert) and September 2013 through September 2014 (post-CPOE alert) INTERVENTION In August of 2013, we implemented a CPOE alert advising against testing in infants and young children based on the American Academy of Pediatrics recommendations with an optional override. We further offered healthcare providers educational seminars regarding recommended C. difficile testing. RESULTS The average monthly testing rate significantly decreased after the CPOE alert for children 0-11 months old (11.5 pre-alert vs 0 post-alert per 10,000 patient days; P<.001) and 12-35 months old (61.6 pre-alert vs 30.1 post-alert per 10,000 patients days; P<.001), but not for those children ≥36 months old (50.9 pre-alert vs 46.4 post-alert per 10,000 patient days; P=.3) who were not targeted with a CPOE alert. There were no complications in those children who testing positive for C. difficile. CONCLUSIONS The average monthly testing rate for C. difficile for children <35 months old decreased without complication after the use of a CPOE alert in those who tested positive for C. difficile. Infect Control Hosp Epidemiol 2017;38:542-546.
authors.affiliation: 1Division of Pediatric Gastroenterology,Hepatology,and Nutrition,Vanderbilt University Medical Center,Nashville,Tennessee.
authors.forename: Maribeth R
authors.initials: MR
authors.lastname: Nicholson
authors.affiliation: 2Division of Pediatric Gastroenterology,Hepatology,and Nutrition,Helen DeVos Children's Hospital,Grand Rapids,Mighigan.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Freswick
authors.affiliation: 3Division of Pediatric Infectious Diseases,Atlantic Health System,Morristown,New Jersey.
authors.forename: M Cecilia
authors.initials: MC
authors.lastname: Di Pentima
authors.affiliation: 4Department of Biostatistics,Vanderbilt University,Nashville,Tennessee.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: 5Division of Pediatric Infectious Diseases,Vanderbilt University Medical Center,Nashville,Tennessee.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Edwards
authors.affiliation: 5Division of Pediatric Infectious Diseases,Vanderbilt University Medical Center,Nashville,Tennessee.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Wilson
authors.affiliation: 6Division of Infectious Diseases,Vanderbilt University Medical Center,Nashville,Tennessee.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Talbot
mesh_terms: D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification*; D020000:Decision Support Systems, Clinical; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D050316:Medical Order Entry Systems; D017410:Practice Guidelines as Topic; D012044:Regression Analysis; D013714:Tennessee