Inappropriate gastrointestinal (GI) testing has been reduced by almost half at a hospital in the Midwestern US through the implementation of an electronic diagnostic stewardship programme, saving thousands of dollars.

Researchers at the University of Nebraska implemented clinical decision support tools into the electronic health records (EHR) of an 870-bed hospital. Over the course of 15 months this reduced incidences of inappropriate testing by 46% and saved an estimated $168,000. The results have now been published in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

The tools were programmed to provide informational best practice alerts on appropriate use and alternative testing, as well as a ‘hard stop’ command which completely prohibited the ordering of gastrointestinal pathogen panel (GIPP) tests for patients who had been previously tested or hospitalised for more than 72 hours.

GIPP tests are carried out on stool samples from patients with diarrhoeal illnesses to determine whether or not they have an infection of their digestive tract due to pathogenic bacteria, parasites or viruses. The GIPP can detect the genetic material of 22 common disease-causing organisms.

While they are useful for patients earlier in their hospital admission who may have been exposed to a wider variety of pathogens, GIPP is considered unnecessary for patients later in their stay or who have already had a GIPP test for the same set of symptoms.

University of Nebraska Medical Center associate medical director of antimicrobial stewardship at and lead author of the study Jasmine Marcelin said: “We can improve the care we deliver by hardwiring criteria for appropriate test ordering and diagnostic stewardship into the EHR.

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“We found that when it comes to diarrhoeal illnesses in the hospital, asking physicians to reconsider if the testing is appropriate through hardwired alerts saves money without compromising quality of care.”

For 15 months prior to the implementation of the hard stop, the hospital implemented the GIPP test for patients with 63 diarrhoeal illnesses as a replacement for a traditional stool culture test. The test was performed daily at the hospital. During this time, 21.5% of GIPP tests ordered were implemented in inappropriate circumstances.

From April 2017 onward, the researchers implemented the hard stop tool in the EHR. Following these changes, only 4.9% of GIPP tests were found to have been used in inappropriate circumstances.

Researchers concluded that the electronic interventions reduced testing by 46% and saved a potential $168,000, even after accounting for the cost of alternate testing.

They now hypothesise that future research on electronic diagnostic stewardship may include the evaluation of outcomes such as length of hospital stay, or focus on the reduction of inappropriate antibiotic use with a hard stop. There is also potential for this approach to be applied to similar laboratory tests.