Impact of Mandatory Infectious Disease Specialist Approval on Hospital-Onset Clostridioides difficile Infection Rates and Testing Appropriateness.

This article examines the impact of a mandatory infectious diseases (ID) specialist approval policy on hospital-onset Clostridioides difficile infection (HO-CDI) rates and testing appropriateness at a 697-bed academic hospital. The study compared three periods: no decision support, computerized decision support, and an intervention requiring ID approval for C. difficile testing on hospital day 4 or later. Implementation of the ID approval process was feasible, achieved 85% provider adherence, and was associated with a greater than 50% reduction in HO-CDI rates and improved appropriateness of testing compared to prior periods. The findings suggest that ID specialists can play a significant role in diagnostic stewardship by enforcing appropriate C. difficile testing, although the intervention required dedicated staffing and led to some delayed diagnoses in a small subset of patients.