Improving Appropriate Diagnosis of

Background Inappropriate testing for Clostridioides difficile leads to overdiagnosis of C difficile infection (CDI). We determined the effect of a computerized clinical decision support (CCDS) order set on C difficile polymerase chain reaction (PCR) test utilization and clinical outcomes. Methods This study is an interrupted time series analysis comparing C difficile PCR test utilization, hospital-onset CDI (HO-CDI) rates, and clinical outcomes before and after implementation of a CCDS order set at 2 academic medical centers: University of Washington Medical Center (UWMC) and Harborview Medical Center (HMC). Results Compared with the 20-month preintervention period, during the 12-month postimplementation of the CCDS order set, there was an immediate and sustained reduction in C difficile PCR test utilization rates at both hospitals (HMC, −28.2% [95% confidence interval {CI}, −43.0% to −9.4%], P = .005; UWMC, −27.4%, [95% CI, −37.5% to −15.6%], P
Implementation of a computerized clinical decision support (CCDS) order set significantly reduced C difficile PCR test utilization rates and was not associated with an increase in severe CDI or CDI-related complications including ICU transfer, 30-day mortality, and toxic megacolon.