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Article
February 16, 1990

Inappropriate Testing for Diarrheal Diseases in the Hospital

Author Affiliations

From the Clinical Microbiology Laboratory, Hospital of the University of Pennsylvania, and Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia.

From the Clinical Microbiology Laboratory, Hospital of the University of Pennsylvania, and Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia.

JAMA. 1990;263(7):979-982. doi:10.1001/jama.1990.03440070067034
Abstract

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.

(JAMA. 1990;263:979-982)

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