Inappropriate testing for diarrheal diseases in the hospital

JAMA. 1990 Feb 16;263(7):979-82.


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.

MeSH terms

  • Adult
  • Campylobacter / isolation & purification
  • Clinical Laboratory Techniques / statistics & numerical data*
  • Clostridium / isolation & purification
  • Data Collection
  • Diarrhea / diagnosis*
  • Diarrhea / microbiology
  • Diarrhea / parasitology
  • Feces / microbiology*
  • Feces / parasitology
  • Health Services / statistics & numerical data*
  • Health Services Misuse / statistics & numerical data*
  • Hospital Bed Capacity, 500 and over
  • Humans
  • Inpatients
  • Outpatients
  • Parasite Egg Count
  • Philadelphia
  • Retrospective Studies
  • Salmonella / isolation & purification
  • Shigella / isolation & purification