Positive impact of a diagnostic stewardship intervention on syndromic panel ordering practices and inappropriate treatment.

OBJECTIVE

Multiplex polymerase chain reaction (PCR) panels for stool testing may be used to diagnose , which can circumvent more appropriate targeted testing, resulting in treatment of incidentally detected colonization. We sought to reduce diagnosis via a gastrointestinal pathogen panel (GIPP).

DESIGN

Quasi-experimental, pre/post, retrospective cohort study from January 1, 2022, to January 31, 2024.

SETTING

Mayo Clinic Arizona-a single academic medical center and associated clinics.

PATIENTS

Adult patients receiving testing and/or treatment.

METHODS

Preferred testing consisted of glutamate dehydrogenase and toxin antigen immunoassay, followed by toxin gene testing for discrepant results. The GIPP contained 22 targets during the baseline period with removed during the postintervention period. Surveys were provided to provider and nursing groups, separately, to identify ordering practices and knowledge gaps.

RESULTS

At baseline, from January 1, 2022, to January 31, 2023, 2,772 GIPPs were completed for 2,307 unique patients (∼7 per day), primarily for outpatients (1,805 of 2,772, 65%). The most common positive target was (517 of 1,018, 51%), which resulted in treatment for infection in 94.9% (337 of 355) of cases. Following GIPP target removal, GIPP orders decreased from 3.23 to 2.7 per 1,000 patient visits ( < .001). Prescribing of treatments decreased in the postintervention period in inpatient and outpatient settings. There were no cases of delayed diagnosis during the postintervention period.

CONCLUSIONS

Removing from the GIPP resulted in effective diagnostic and antimicrobial stewardship without resulting in delayed diagnoses.