EHR With Decision Support Reduced Unnecessary GIPP Testing, Saved Money

Researchers found that hardwiring a hospital’s electronic health record (EHR) system to provide data on the appropriate times to order Gastrointestinal Pathogen Panel (GIPP) nearly halved the amount of inappropriate testing.

The findings, published in Infection Control & Hospital Epidemiology and simultaneously in a Society for Healthcare Epidemiology of America (SHEA) white paper, show that the 46% reduction of inappropriate testing over a 15-month period saved up to $168,000.

The study consisted of researchers hardwiring criteria in the EHR that would prompt best practices alerts and indicate “hard stop” points that would prevent the costly GIPP, a panel that detects 22 common disease-causing organisms, from being unnecessarily requested. The panel is typically ordered for newer patients with potential exposure to a variety of pathogens but is not needed more than once or for patients further into their hospital stay.

“We can improve the care we deliver by hardwiring criteria for appropriate test ordering and diagnostic stewardship into the electronic health record,” said Jasmine R Marcelin, MD, associate medical director of antimicrobial stewardship at University of Nebraska Medical Center and lead author of the study, in a press release. “We found that when it comes to diarrheal illnesses in the hospital, asking physicians to reconsider if the testing is appropriate through hardwired alerts saves money without compromising quality of care.”

Before the criteria was included in the hospital EHR, 21.5% of the GIPP tests ordered over an equal 15-month period were deemed unnecessary. The study found the added criteria lowered inappropriate testing requests to 4.9%.  “Researchers concluded that the diagnostic stewardship intervention, including both the best practice alert and hard stop, reduced testing by 46% for a potential savings of $168,000, even after accounting for the cost of alternative testing,” stated a press release about the study.

“As this study demonstrates, automated clinical decision support rules that are built into these systems can help facilitate action, leading to appropriate antimicrobial stewardship, and use of laboratory tests when used intentionally,” said Kristi Kuper, PharmD, BCPS, senior clinical manager for infectious diseases in the Center for Pharmacy Practice Excellence at Vizient, and lead author of the SHEA white paper, in a press release.

Dr Marcelin went on to say that “future research on diagnostic stewardship could include the evaluation of outcomes like length of hospital stay or reduction of inappropriate antibiotic use associated with a hard stop, and these
tactics could be applied to similar laboratory tests.”—Edan Stanley