Date on Paper


Document Type

Doctoral Paper

Degree Name




Committee Chair

Ross, Ratchneewan

Committee Member

Huntington-Moskos, Luz

Author's Keywords

Clostridioides difficile; C. difficile; electronic health record; clinical decision support; EHR


Background: Clostridioides difficile infection (CDI) commonly impacts hospitalized patients with almost half a million cases reported in the United States annually. C. difficile colonization is more common than infection. Identifying true infection versus colonization is critical to avoiding inappropriate treatment, unnecessary exposure to antibiotics, and increased cost of care. Implementation of evidenced-based CDI testing criteria can help reduce inappropriate CDI testing and avoid the misidentification of colonized patients as true CDI.

Purpose: The purpose of this project was to evaluate the effectiveness of an evidence-based electronic health record (EHR) integrated CDI testing algorithm in reducing inappropriate CDI testing among adult inpatients.

Methods: A retrospective review of outcomes data were analyzed to assess CDI algorithm effectiveness.

Intervention: Three order rules were implemented into the EHR; (1) Order stopped if negative C. difficile result in past 7 days, (2) Order stopped if positive C. difficile result in past 28 days, and (3) Order stopped if patient has received a laxative within 48 hours. These rules were developed as “hard stops” which clinicians could not bypass.

Results: A significant reduction was achieved in both the number of CDI tests performed and CDI testing rate (61% decrease; z= -19.90, ppp<.001).

Discussion: Implementation of an evidence-based EHR integrated CDI testing algorithm is an effective way to reduce the number of inappropriate CDI tests performed and testing rates.

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