Inappropriate testing for diarrheal diseases in the hospital. 1990

D L Siegel, and P H Edelstein, and I Nachamkin
Clinical Microbiology Laboratory, Hospital of the University of Pennsylvania, Philadelphia 19104-4283.

To assess the degree to which routine stool cultures, ova and parasite examinations, and Clostridium difficile toxin assays may be inappropriately ordered on hospitalized patients, we conducted a retrospective study to determine the relative yield of these tests on specimens collected from outpatients and inpatients as a function of time after admission. During a 3-year period, only 1 of 191 positive stool cultures and none of the 90 ova and parasite examinations with positive results were from the group of patients who had stool specimens submitted after 3 days of hospitalization. Analysis of laboratory work load for a 1-year period showed that specimens from this patient group contributed nearly 50% of the more than 3000 specimens received each year. In contrast, approximately 25% (range, 17% to 33%) of samples, regardless of admission status, were positive for C difficile toxin. Eliminating routine stool cultures and ova and parasite examinations on hospitalized patients would significantly reduce hospital and patient costs without altering patient care. Nationwide, such a policy might achieve a cost savings of +20 to +30 million per year.

UI MeSH Term Description Entries
D007297 Inpatients Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment. Inpatient
D010045 Outpatients Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. Out-patients,Out patients,Out-patient,Outpatient
D010270 Parasite Egg Count Determination of parasite eggs in feces. Count, Parasite Egg,Counts, Parasite Egg,Egg Count, Parasite,Egg Counts, Parasite,Parasite Egg Counts
D002167 Campylobacter A genus of bacteria found in the reproductive organs, intestinal tract, and oral cavity of animals and man. Some species are pathogenic.
D003013 Clostridium A genus of motile or nonmotile gram-positive bacteria of the family Clostridiaceae. Many species have been identified with some being pathogenic. They occur in water, soil, and in the intestinal tract of humans and lower animals.
D003625 Data Collection Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. Data Collection Methods,Dual Data Collection,Collection Method, Data,Collection Methods, Data,Collection, Data,Collection, Dual Data,Data Collection Method,Method, Data Collection,Methods, Data Collection
D003967 Diarrhea An increased liquidity or decreased consistency of FECES, such as running stool. Fecal consistency is related to the ratio of water-holding capacity of insoluble solids to total water, rather than the amount of water present. Diarrhea is not hyperdefecation or increased fecal weight. Diarrheas
D005243 Feces Excrement from the INTESTINES, containing unabsorbed solids, waste products, secretions, and BACTERIA of the DIGESTIVE SYSTEM.
D006296 Health Services Services for the diagnosis and treatment of disease and the maintenance of health. Services, Health,Health Service
D006300 Health Services Misuse Excessive, under or unnecessary utilization of health services by patients or physicians. Abuse of Health Services,Misuse of Health Services,Health Services Underuse,Health Services Underutilization,Misuse, Health Services,Underuse, Health Services,Health Services Abuse,Health Services Abuses,Health Services Misuses,Health Services Underuses,Health Services Underutilizations,Misuses, Health Services,Underuses, Health Services,Underutilization, Health Services,Underutilizations, Health Services

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