Clostridium difficile infection in inflammatory bowel disease: A nursing-based quality improvement strategy

Objectives: Patients with inflammatory bowel disease (IBD) have a higher prevalence of Clostridium difficile infection (CDI) and worse outcomes. Research has highlighted the inconsistent care that is provided to patients with IBD, and at our institution, the CDI testing rate was 41%. The present quality improvement intervention sought to increase CDI testing for inpatients with IBD with a flare. Methods: Eighty-nine patients admitted to our gastrointestinal unit over a 9-month period with IBD flare were eligible for the study. If a patient did not have a test for CDI ordered, the floor nurse collected stool and alerted the provider to order the test. The primary outcome was percent of eligible patients receiving a test. Secondary outcomes included rate of CDI, length of hospital stay, and readmission rate within 6 months. Results: There was a significant increase in testing for CDI to 75% (p = .0151). Patients who received a test were more likely to have CDI (p = .0316), shorter hospital stays (p = .0095), and fewer readmissions (p = .0366). Conclusion: This study used the nursing admission workflow to increase the rate of CDI testing. Future studies should further characterize inconsistencies in IBD care and implement quality improvements.