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Clostridioides difficile (C. difficile) is a serious infection, causing life-threatening diarrhea. Patients with C. difficile will have liquid, loose, mucous-like, or non-formed stools. The financial burden of C. difficile infection (CDI) is substantial, increasing costs up to an additional $32,000 during hospitalization. These patients can have complications leading to surgical intervention, longer length of stay, and are at risk for recurrent infection, which further adds to healthcare cost. Each year nearly 500,000 people in the United States develop CDI. Although C. difficile is historically classified as a hospital acquired condition, the incidence of community acquired CDI (CA-CDI) has increased. Classification of CDI is dependent upon hospital day. Positive stool samples collected within the first 3 calendar days of admission are classified as CA-CDI. Positive samples collected on calendar day 4 or after are hospital acquired CDI (HA-CDI). The institution had an existing nurse-driven C. difficile testing (CDT) protocol in place. According to the protocol, patients with mushy, loose, liquid/watery stool or clinical suspicion of C. difficile within 3 calendar days of admission are to be tested. Nurses can order CDT and isolation in the electronic medical record (EMR) without a provider co-signature. After calendar day 3, an automated C. difficile test-order hard-stop appears if patients received recent promotility agents, were tested in the last week, or previously tested positive during the admission.

Problem Statement: The surgical intensive care unit (SICU) at Henry Ford Hospital experienced low incidence of CDT during the first 3 calendar days of admission and high rates of HA-CDI in 2019 and 2020.

Improvement Statement: The goal was to use an electronic medical record (EMR) report to conduct early screening for patients on the SICU to improve capture of CA-CDI by at least 50% by the end of 2022.

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Henry Ford Health


Detroit, Michigan


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Project #18: Improving Early Detection of Clostridioides difficile Infections Through Electronic Reports



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