Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: a randomized controlled trial

Jessina C McGregor; Elizabeth Weekes; Graeme N Forrest; Harold C Standiford; Eli N Perencevich; Jon P Furuno; Anthony D Harris

doi:10.1197/jamia.M2049

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Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: a randomized controlled trial

Journal article

Open access

Peer reviewed

Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: a randomized controlled trial

Jessina C McGregor, Elizabeth Weekes, Graeme N Forrest, Harold C Standiford, Eli N Perencevich, Jon P Furuno and Anthony D Harris

Journal of the American Medical Informatics Association : JAMIA, Vol.13(4), pp.378-384

07/2006

DOI: 10.1197/jamia.M2049

PMCID: PMC1513678

PMID: 16622162

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Abstract

Many hospitals utilize antimicrobial management teams (AMTs) to improve patient care. However, most function with minimal computer support. We evaluated the effectiveness and cost-effectiveness of a computerized clinical decision support system for the management of antimicrobial utilization. A randomized controlled trial in adult inpatients between May 10 and August 3, 2004. Antimicrobial utilization was managed by an existing AMT using the system in the intervention arm and without the system in the control arm. The system was developed to alert the AMT of potentially inadequate antimicrobial therapy. Outcomes assessed were hospital antimicrobial expenditures, mortality, length of hospitalization, and time spent managing antimicrobial utilization. The AMT intervened on 359 (16%) of 2,237 patients in the intervention arm and 180 (8%) of 2,270 in the control arm, while spending approximately one hour less each day on the intervention arm. Hospital antimicrobial expenditures were $285,812 in the intervention arm and $370,006 in the control arm, for a savings of $84,194 (23%), or $37.64 per patient. No significant difference was observed in mortality (3.26% vs. 2.95%, p = 0.55) or length of hospitalization (3.84 vs. 3.99 days, p = 0.38). Use of the system facilitated the management of antimicrobial utilization by allowing the AMT to intervene on more patients receiving inadequate antimicrobial therapy and to achieve substantial time and cost savings for the hospital. This is the first study that demonstrates in a patient-randomized controlled trial that computerized clinical decision support systems can improve existing antimicrobial management programs.

Reminder Systems

Drug Therapy, Computer-Assisted

Humans

Anti-Infective Agents - therapeutic use

Adult

Decision Support Systems, Clinical

Health Services Misuse

Details

Title: Subtitle: Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: a randomized controlled trial
Creators: Jessina C McGregor - Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, 100 North Greene Street, Lower Level, Baltimore, MD 21201, USA. jmcgrego@epi.umaryland.edu
Elizabeth Weekes
Graeme N Forrest
Harold C Standiford
Eli N Perencevich
Jon P Furuno
Anthony D Harris
Resource Type: Journal article
Publication Details: Journal of the American Medical Informatics Association : JAMIA, Vol.13(4), pp.378-384
DOI: 10.1197/jamia.M2049
PMID: 16622162
PMCID: PMC1513678
NLM abbreviation: J Am Med Inform Assoc
ISSN: 1067-5027
eISSN: 1527-974X
Publisher: England
Grant note: R44 NR008958 / NINR NIH HHS R44NR008958A / NINR NIH HHS
Language: English
Date published: 07/2006
Academic Unit: Epidemiology; Internal Medicine
Record Identifier: 9983779490402771

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