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C. difficile testing now automatically ordered for certain patients

Yale New Haven Health recently implemented a process to automatically order C. difficile testing for newly hospitalized patients identified as having diarrhea.

According to the process, which took effect Jan. 3, an order for LAB7877 C. DIFFICILE ASSAY will automatically and silently be generated in the Emergency Department or for inpatients during the first few days of admission who have:

  • An admission diagnosis or chief complaint of diarrhea
  • Nursing documentation indicating diarrhea in nursing flow sheets

A clinician co-sign will be required. The C. difficile assay order will populate the task list to be collected.

The new process was prompted by delays in ordering C. difficile testing for patients meeting these criteria, which led to delays in diagnoses of community-acquired C. difficile infection (CDI), delays in appropriate treatment and prolonged hospitalization.

In addition, these patients’ C. difficile infection (CDI) could be misclassified as being hospital-acquired. Failure to diagnose community-acquired CDI within the first three days of hospitalization penalizes YNHHS hospitals both in quality measures (such as Centers for Medicare and Medicaid Star Ratings and Leapfrog Hospital Safety Grades) as well as financially (in hospital-acquired condition penalties).