2343. How Smart Is the Chart? Accuracy of the Medical Record in Documenting Diarrhea in Patients Tested for Clostridium difficile Infection

BACKGROUND: Inappropriate testing for Clostridium difficile infection (CDI) may result in diagnosis of CDI in asymptomatic carriers with diarrhea due to other causes such as laxatives. Current guidelines suggest that periodic chart review may be useful to assess the appropriateness of CDI testing, but it is not known how accurate the medical record is in documenting diarrhea. METHODS: We conducted a prospective cohort study of 80 patients tested for CDI to determine the accuracy of diarrhea documentation in the medical record in comparison to patient interviews and to assess the appropriateness of testing. RESULTS: Thirty-five of 80 (44%) CDI tests were deemed inappropriate because patients either did not have clinically significant diarrhea (i.e., 3 or more unformed stools per day) or had an alternative explanation for diarrhea. Seventy-four of 80 (93%) patients stated they had diarrhea, but only 53 (66%) had clinically significant diarrhea based on symptom review. Physician and/or nursing notes documented diarrhea in 67 of 80 (84%) patients, but the number of bowel movements and the consistency of stool were documented for only 36 (45%) and 41 (51%) patients. CONCLUSION: In our facility, inappropriate CDI testing was common and the accuracy of the medical record in documenting diarrhea was suboptimal. Education of patients and providers may be beneficial in improving the accuracy of diarrhea documentation and the appropriateness of testing. DISCLOSURES: All authors: No reported disclosures.