Improving follow-up testing in children with Shiga toxin-producing Escherichia coli through provision of a provider information sheet.

The aim of this study was to improve follow-up laboratory testing for children infected by Shiga toxin-producing Escherichia coli (STEC) through the provision of an information sheet to healthcare providers in the province of Alberta, Canada. An information sheet recommending the performance of laboratory tests, every 24-48h until 3 days after diarrhoea resolves or the platelet count stabilises or begins to rise, was sent to all physicians who ordered a STEC-positive stool test as of 1 November 2016. The information sheet was only distributed to physicians in one of the province's five healthcare delivery zones (i.e. intervention zone). Medical records for children aged <18 years with laboratory confirmed STEC-positive stool samples between November 2014 and November 2018 were reviewed to determine the performance of recommended laboratory tests. Post-intervention, follow-up testing in all categories increased significantly for cases that occurred in the intervention zone, with odds ratios (OR) ranging from 3.02 (95% CI: 1.35-6.78) to 3.94 (95% CI: 1.70-9.16) when compared with pre-intervention. No increase in any of the laboratory testing categories was detected outside of the intervention zone. The provision of a targeted information sheet to healthcare providers improved the monitoring of STEC-infected children.